Provider Demographics
NPI:1609531078
Name:KRUMHOLZ, MIRIAM FAYE (PSYD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:FAYE
Last Name:KRUMHOLZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 MARKET ST STE 809
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-1828
Mailing Address - Country:US
Mailing Address - Phone:415-627-9095
Mailing Address - Fax:
Practice Address - Street 1:833 MARKET ST STE 809
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-1828
Practice Address - Country:US
Practice Address - Phone:415-627-9095
Practice Address - Fax:415-627-9108
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024429-01103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY024429-01OtherPSYCHOLOGIST LICENSE