MEDICARE: MIRIAM FAYE KRUMHOLZ PSYD

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	103T00000X	Psychologist	024429-01	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	024429-01	OTHER	NY	PSYCHOLOGIST LICENSE

General Provider Information

NPI Number	:	1609531078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM FAYE KRUMHOLZ PSYD

Provider Business Mailing Address
First Line	:	833 MARKET ST STE 809
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94103-1828
Country	:	US
Telephone Number	:	415-627-9095
Fax Number	:

Provider Business Practice Location Address
First Line	:	833 MARKET ST STE 809
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94103-1828
Country	:	US
Telephone Number	:	415-627-9095
Fax Number	:	415-627-9108

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

Provider Enumeration Date	:	11/01/2021
Last Update Date	:	11/01/2021

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