Provider Demographics
NPI:1245694504
Name:BACH, MARIAM (MH9051)
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:BACH
Suffix:
Gender:F
Credentials:MH9051
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 NE 154TH STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-6022
Mailing Address - Country:US
Mailing Address - Phone:305-949-2924
Mailing Address - Fax:305-949-9038
Practice Address - Street 1:1926 NE 154TH STREET
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-6022
Practice Address - Country:US
Practice Address - Phone:305-949-2924
Practice Address - Fax:305-949-9038
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9051101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor