Provider Demographics
NPI:1407574395
Name:MIASSO, KALY HAMO
Entity Type:Individual
Prefix:
First Name:KALY
Middle Name:HAMO
Last Name:MIASSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 SENTER RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-1053
Mailing Address - Country:US
Mailing Address - Phone:925-913-0360
Mailing Address - Fax:
Practice Address - Street 1:2450 SENTER RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-1053
Practice Address - Country:US
Practice Address - Phone:925-913-0360
Practice Address - Fax:408-564-0303
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)