Provider Demographics
NPI:1558637157
Name:DUM, MARIAM (PHD)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:DUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 N E 208 TERRACE
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2876
Mailing Address - Country:US
Mailing Address - Phone:786-553-4546
Mailing Address - Fax:
Practice Address - Street 1:2750 NE 185TH ST
Practice Address - Street 2:SUIT 305
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2876
Practice Address - Country:US
Practice Address - Phone:786-553-4546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 8498103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist