Provider Demographics
NPI:1033958111
Name:SERAFIM, MIRIAN F
Entity type:Individual
Prefix:
First Name:MIRIAN
Middle Name:F
Last Name:SERAFIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4034 S DEMAREE ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-9476
Mailing Address - Country:US
Mailing Address - Phone:559-738-0700
Mailing Address - Fax:559-738-0710
Practice Address - Street 1:1100 W CENTER AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5913
Practice Address - Country:US
Practice Address - Phone:559-738-0700
Practice Address - Fax:559-738-0710
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16527101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional