Provider Demographics
NPI:1861717118
Name:SURVAL, MIRIAM (CSW)
Entity type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:
Last Name:SURVAL
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:
Other - Last Name:SURVAL-ARM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:1040 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2906
Mailing Address - Country:US
Mailing Address - Phone:914-737-8217
Mailing Address - Fax:
Practice Address - Street 1:1040 MAIN ST
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-2906
Practice Address - Country:US
Practice Address - Phone:914-737-8217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68900531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical