Provider Demographics
NPI:1659479442
Name:BORAZ, MIRIAM (PHD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:BORAZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:
Other - Last Name:BORAZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:3601 GREEN RD
Mailing Address - Street 2:BEACHWOOD
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5725
Mailing Address - Country:US
Mailing Address - Phone:216-645-1003
Mailing Address - Fax:
Practice Address - Street 1:3601 GREEN RD
Practice Address - Street 2:BEACHWOOD
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5725
Practice Address - Country:US
Practice Address - Phone:216-645-1003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6205103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000389939OtherANTHEM BC & BS
OHP00301310OtherRAILROAD MEDICARE
OH000000389939OtherANTHEM BC & BS