Provider Demographics
NPI:1013994037
Name:DAVIES, MIRIAM (MED, NCSP)
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:
Last Name:DAVIES
Suffix:
Gender:F
Credentials:MED, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S MARKET ST
Mailing Address - Street 2:LIGONIER VALLEY LEARNING CENTER INC
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-1214
Mailing Address - Country:US
Mailing Address - Phone:724-238-0355
Mailing Address - Fax:724-238-0352
Practice Address - Street 1:117 JUNIPER LN
Practice Address - Street 2:LIGONIER VALLEY LEARNING CENTER INC
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-9727
Practice Address - Country:US
Practice Address - Phone:724-238-5556
Practice Address - Fax:724-238-9533
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008125L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1001348580007Medicaid