Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PS008125L | PA |
Y | 103T00000X | Psychologist | PS008125L | PA |
NPI | 1013994037 |
---|---|
Provider Name | Ms. Miriam Davies |
First Address | Ligonier, PA 15658-1214 |
Second Address | Ligonier, PA 15658-9727 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1001348580007 | (05) | PA |