Provider Demographics
NPI:1568023752
Name:JAMESON, MIRIAM GABRIELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:GABRIELLE
Last Name:JAMESON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:GABRIELLE
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:605 HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-8312
Mailing Address - Country:US
Mailing Address - Phone:402-968-2765
Mailing Address - Fax:
Practice Address - Street 1:200 MERCY CIRCLE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:402-968-2765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99432101YM0800X
TX67814104100000X
CA1047551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker