Provider Demographics
NPI:1407105802
Name:THORP, MIRIAM (LISW)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:THORP
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 OPPENHEIMER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-2384
Mailing Address - Country:US
Mailing Address - Phone:505-660-5726
Mailing Address - Fax:
Practice Address - Street 1:555 OPPENHEIMER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-2384
Practice Address - Country:US
Practice Address - Phone:505-660-5726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI048851041S0200X
NMI-048851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool