Healthcare Provider Details

I. General information

NPI: 1639947831
Provider Name (Legal Business Name): MIRIAM GOLDA ZEHAVA HUTTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 12/18/2023
Certification Date: 12/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8866 ALCOTT ST APT 201
LOS ANGELES CA
90035-3366
US

IV. Provider business mailing address

8866 ALCOTT ST APT 201
LOS ANGELES CA
90035-3366
US

V. Phone/Fax

Practice location:
  • Phone: 917-882-3057
  • Fax:
Mailing address:
  • Phone: 917-882-3057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW100696
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: