Provider Demographics
NPI:1881373959
Name:HERMOSO, MIRIAM J
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:J
Last Name:HERMOSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 FIGUEROA DR # C
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-5625
Mailing Address - Country:US
Mailing Address - Phone:626-328-5290
Mailing Address - Fax:
Practice Address - Street 1:147 FIGUEROA DR # C
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-5625
Practice Address - Country:US
Practice Address - Phone:626-328-5290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA284869101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health