Provider Demographics
NPI:1134496169
Name:BAR, MIRIAM
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:
Last Name:BAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 EL CAJON WAY
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-3408
Mailing Address - Country:US
Mailing Address - Phone:650-494-1521
Mailing Address - Fax:
Practice Address - Street 1:560 OXFORD AVE
Practice Address - Street 2:#8
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1153
Practice Address - Country:US
Practice Address - Phone:650-813-1270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3332106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist