Provider Demographics
NPI:1831212711
Name:DUNFORD, MIRIAM M (LCSW)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:M
Last Name:DUNFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 E 2700 S
Mailing Address - Street 2:SUITE 180
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-1700
Mailing Address - Country:US
Mailing Address - Phone:801-466-8400
Mailing Address - Fax:801-322-3890
Practice Address - Street 1:2005 E 2700 S
Practice Address - Street 2:SUITE 180
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-1700
Practice Address - Country:US
Practice Address - Phone:801-466-8400
Practice Address - Fax:801-322-3890
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT133120-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical