Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3137 | CA |
Y | 103T00000X | Psychologist | 3137 | CA |
N | 103TS0200X | School Psychologist | 3137 | CA |
NPI | 1033589239 |
---|---|
Provider Name | Miranda Boe |
First Address | Sherman Oaks, CA 91403-1634 |
Second Address | Sherman Oaks, CA 91403-1634 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2015 |
Last Update Date | 30/09/2015 |