Provider Demographics
NPI:1467784454
Name:NISENBAUM, MIRIAM L (ACSW, LMSW)
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:L
Last Name:NISENBAUM
Suffix:
Gender:F
Credentials:ACSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4804 MISTY BROOK CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-6817
Mailing Address - Country:US
Mailing Address - Phone:512-615-6802
Mailing Address - Fax:512-615-7121
Practice Address - Street 1:1611 HEADWAY CIR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-5160
Practice Address - Country:US
Practice Address - Phone:512-615-6802
Practice Address - Fax:512-615-7121
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00632171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator