Healthcare Provider Details

I. General information

NPI: 1801221536
Provider Name (Legal Business Name): MIRIAM MIER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2013
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 CEDAR ST
ROCKLEDGE FL
32955
US

IV. Provider business mailing address

400 SHERIDAN RD
MELBOURNE FL
32901-3184
US

V. Phone/Fax

Practice location:
  • Phone: 321-890-1500
  • Fax:
Mailing address:
  • Phone: 321-722-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License NumberISW8291
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: