Provider Demographics
NPI:1679644298
Name:FRANCO, MIRIAM (PSYD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:FRANCO
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 1:106 JEFFORDS CT
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-2841
Mailing Address - Country:US
Mailing Address - Phone:610-935-8330
Mailing Address - Fax:
Practice Address - Street 1:106 JEFFORDS CT
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-2841
Practice Address - Country:US
Practice Address - Phone:610-935-8330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PWPS015002103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA063894Medicare ID - Type Unspecified