Healthcare Provider Details

I. General information

NPI: 1962740464
Provider Name (Legal Business Name): BARBARA E MINER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2013
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 S RAYMOND AVE SUITE 7
PASADENA CA
91105-1960
US

IV. Provider business mailing address

32 S RAYMOND AVE SUITE 7
PASADENA CA
91105-1960
US

V. Phone/Fax

Practice location:
  • Phone: 626-792-4500
  • Fax:
Mailing address:
  • Phone: 626-792-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY23850
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: