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General NPI Number Information
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NPI Number | 1508125998
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Entity Type | Organization
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Legal Business Name | MIRIAM HAMIDEH, PH. D., CLINICAL PSYCHOLOGIST, INC.
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Dates
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Enumeration Date | 05/07/2012
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Last Update Date | 07/01/2020
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Provider Practice Location Address
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Address Line | 31194 LA BAYA DR STE 201
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91362-6431
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Country | US
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Telephone | 805-797-7875
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Fax |
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Provider Business Mailing Address
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Address Line | 31194 LA BAYA DR STE 201
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91362-6431
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Country | US
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Telephone | 805-338-2209
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Fax | 310-919-3755
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST/PRESIDENT
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Name | DR. MIRIAM HAMIDEH
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Credential | PHD
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Telephone | 805-797-7875
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | PSY17320
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License Number State | CA
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