Provider Demographics
NPI:1164809513
Name:BHUTTA, MIRIAM ALI (MHC)
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:ALI
Last Name:BHUTTA
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 E 14TH ST
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2933
Mailing Address - Country:US
Mailing Address - Phone:718-375-1200
Mailing Address - Fax:
Practice Address - Street 1:829 E 14TH ST
Practice Address - Street 2:APARTMENT 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2933
Practice Address - Country:US
Practice Address - Phone:718-375-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health