Provider Demographics
NPI:1902499064
Name:ADAMO, MIRIAM P (MFT)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:P
Last Name:ADAMO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 E AVENUE I SPC 79
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-1009
Mailing Address - Country:US
Mailing Address - Phone:818-448-5612
Mailing Address - Fax:
Practice Address - Street 1:18740 VENTURA BLVD STE 202
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6310
Practice Address - Country:US
Practice Address - Phone:818-448-5612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT118870106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist