Healthcare Provider Details

I. General information

NPI: 1740034867
Provider Name (Legal Business Name): MIRIAM MARCY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 CAMINO REAL
REDONDO BEACH CA
90277-3815
US

IV. Provider business mailing address

410 CAMINO REAL
REDONDO BEACH CA
90277-3815
US

V. Phone/Fax

Practice location:
  • Phone: 310-316-1212
  • Fax:
Mailing address:
  • Phone: 310-316-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: