Provider Demographics
NPI:1245332006
Name:SHAPIRO, MIRIAM F (MFT)
Entity type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:F
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1792 KINGLET CT
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4838
Mailing Address - Country:US
Mailing Address - Phone:714-751-1792
Mailing Address - Fax:714-546-1792
Practice Address - Street 1:1792 KINGLET CT
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4838
Practice Address - Country:US
Practice Address - Phone:714-751-1792
Practice Address - Fax:714-546-1792
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM16623106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist