=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770151482
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. MIRIAM C ARTHUR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2021
-----------------------------------------------------
Last Update Date | 12/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 530 ROUTE 111 STE 333
-----------------------------------------------------
City | HAUPPAUGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11788-4346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-686-4418
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 530 ROUTE 111 STE 333
-----------------------------------------------------
City | HAUPPAUGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11788-4346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-686-4418
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 101603
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------