Provider Demographics
NPI:1508125998
Name:MIRIAM HAMIDEH, PH. D., CLINICAL PSYCHOLOGIST, INC.
Entity Type:Organization
Organization Name:MIRIAM HAMIDEH, PH. D., CLINICAL PSYCHOLOGIST, INC.
Other - Org Name:PCI WESTLAKE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMIDEH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:805-797-7875
Mailing Address - Street 1:31194 LA BAYA DR STE 201
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-6431
Mailing Address - Country:US
Mailing Address - Phone:805-338-2209
Mailing Address - Fax:310-919-3755
Practice Address - Street 1:31194 LA BAYA DR STE 201
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-6431
Practice Address - Country:US
Practice Address - Phone:805-797-7875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17320261QM0850X
324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility