Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | ||
Y | 1041C0700X | Clinical Social Worker | 101097 | CA |
NPI | 1003270505 |
---|---|
Provider Name | Ms. Miriam Ruth Benjamina Feese |
First Address | Weimar, CA 95736-0237 |
Second Address | Weimar, CA 95736 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2016 |
Last Update Date | 03/02/2022 |