Provider Demographics
NPI:1457000937
Name:DESIR, MIRIAM MERCIUS
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:MERCIUS
Last Name:DESIR
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 1:916 COTTON BAY DR E APT 2107
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-9101
Mailing Address - Country:US
Mailing Address - Phone:561-331-7016
Mailing Address - Fax:
Practice Address - Street 1:2979 PGA BLVD STE 20
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3001
Practice Address - Country:US
Practice Address - Phone:561-260-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician