MEDICARE: MS. MIRIAM LIVINGSTON LCSW

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	1041C0700X	Clinical Social Worker
2	1041C0700X	Clinical Social Worker	C-10103	NM
3	1041C0700X	Clinical Social Worker	66284	TX

General Provider Information

NPI Number	:	1487053120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MIRIAM LIVINGSTON LCSW

Provider Business Mailing Address
First Line	:	849 SUNSET PARK DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79932-1839
Country	:	US
Telephone Number	:	915-494-6335
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 W LAS CRUCES AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-1804
Country	:	US
Telephone Number	:	915-494-6335
Fax Number	:

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

Provider Enumeration Date	:	08/19/2014
Last Update Date	:	07/14/2025

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