Healthcare Provider Details

I. General information

NPI: 1508125998
Provider Name (Legal Business Name): MIRIAM HAMIDEH, PH. D., CLINICAL PSYCHOLOGIST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31194 LA BAYA DR STE 201
WESTLAKE VILLAGE CA
91362-6431
US

IV. Provider business mailing address

31194 LA BAYA DR STE 201
WESTLAKE VILLAGE CA
91362-6431
US

V. Phone/Fax

Practice location:
  • Phone: 805-797-7875
  • Fax:
Mailing address:
  • Phone: 805-338-2209
  • Fax: 310-919-3755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberPSY17320
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. MIRIAM HAMIDEH
Title or Position: CLINICAL PSYCHOLOGIST/PRESIDENT
Credential: PHD
Phone: 805-797-7875