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General NPI Number Information
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NPI Number | 1417614579
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Entity Type | Individual
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Provider Name | MIRIAM MONIQUE DEBERRY LMFT
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Gender | Female
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Dates
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Enumeration Date | 11/23/2021
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Last Update Date | 01/11/2024
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Provider Practice Location Address
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Address Line | 4470 W SUNSET BLVD STE 107
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City | LOS ANGELES
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State | CA
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Zip | 90027-6309
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Country | US
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Telephone | 323-701-0371
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 33023
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City | SAN DIEGO
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State | CA
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Zip | 92163-2023
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Country | US
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Telephone | 619-343-2889
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2014006569
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 123881
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License Number State | CA
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