MEDICARE: MIRIAM E STEVENS LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH3072	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z5977	OTHER	FL	BLUE CROSS BLUE SHIELD FL

General Provider Information

NPI Number	:	1003965252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM E STEVENS LMHC

Provider Business Mailing Address
First Line	:	3521 NW 75TH TER
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33319-4928
Country	:	US
Telephone Number	:	954-829-0931
Fax Number	:	954-742-5327

Provider Business Practice Location Address
First Line	:	1040 BAYVIEW DR
Second Line	:	SUITE 534
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-2522
Country	:	US
Telephone Number	:	954-829-0931
Fax Number	:	954-742-5327

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/08/2007

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