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General NPI Number Information
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NPI Number | 1962533042
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Entity Type | Individual
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Provider Name | MIRIAN THOMAS MSW, ASW
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Gender | Female
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3761 STOCKER ST 211
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City | LOS ANGELES
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State | CA
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Zip | 90008-5111
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Country | US
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Telephone | 323-295-2060
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Fax | 323-295-2954
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Provider Business Mailing Address
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Address Line | 3771 LOCKLAND DR #4
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City | LOS ANGELES
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State | CA
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Zip | 90008-3510
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Country | US
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Telephone | 323-290-9141
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ASW 16273
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License Number State | CA
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