Provider Demographics
NPI:1184846164
Name:HALL, MIRIAM ELIZABETH LEWIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:ELIZABETH LEWIS
Last Name:HALL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12625 LA MIRADA BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-2211
Mailing Address - Country:US
Mailing Address - Phone:562-903-4800
Mailing Address - Fax:562-903-4864
Practice Address - Street 1:12625 LA MIRADA BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-2211
Practice Address - Country:US
Practice Address - Phone:562-903-4800
Practice Address - Fax:562-903-4864
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16759103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical