Provider Demographics
NPI:1205860830
Name:MILLER, MARIANN HYBELS (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIANN
Middle Name:HYBELS
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 OZONE AVENUE, EAST DOOR
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405
Mailing Address - Country:US
Mailing Address - Phone:310-397-6106
Mailing Address - Fax:310-392-7114
Practice Address - Street 1:811 OZONE ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5603
Practice Address - Country:US
Practice Address - Phone:310-397-6106
Practice Address - Fax:310-392-7114
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8418103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL84181OtherBLUE SHIELD