Provider Demographics
NPI:1306483367
Name:RICHARDS, MIRIAM VAN DER GRIFT (MS, LMHC)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:VAN DER GRIFT
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 CYPRESS DR STE 3
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33469-3198
Mailing Address - Country:US
Mailing Address - Phone:561-307-4687
Mailing Address - Fax:
Practice Address - Street 1:1660 CYPRESS DR STE 3
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33469-3198
Practice Address - Country:US
Practice Address - Phone:561-373-4697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18569101YM0800X
FL15566101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health