Healthcare Provider Details

I. General information

NPI: 1750204558
Provider Name (Legal Business Name): THE MIRI CENTER, A PROFESSIONAL PSYCHOLOGICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 LENZEN AVE
SAN JOSE CA
95126-2736
US

IV. Provider business mailing address

6081 MERIDIAN AVE STE 70-298
SAN JOSE CA
95120-2752
US

V. Phone/Fax

Practice location:
  • Phone: 408-247-4123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER HOLMBERG
Title or Position: DIRECTOR
Credential: LCSW
Phone: 310-600-8277