Active NPI
Jill Lauren Miron, PSY.D.
- Clinical Psychologist
- Columbia, MD
National Provider Identifier
1104948819
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3014
- Practice address
- 5525 Twin Knolls Rd
Suite 327
Columbia, MD 21045-3266 - Phone
- (410) 992-9149
- Fax
- (410) 992-9921
- NPI assigned
- Apr 4, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 3014 | CO | Primary |
Addresses
Primary practice location
5525 Twin Knolls Rd
Suite 327
Columbia, MD 21045-3266
Mailing address
3200 Timberfield LN
Baltimore, MD 21208-4422
Phone (410) 486-8188
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3014 | CO | MD | Clinical Psychologist |
| 04325 | MD | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104948819",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3200 TIMBERFIELD LN",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212084422",
"telephone_number": "410-486-8188",
"fax_number": "410-992-9921"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5525 TWIN KNOLLS RD",
"address_2": "SUITE 327",
"city": "COLUMBIA",
"state": "MD",
"postal_code": "210453266",
"telephone_number": "410-992-9149",
"fax_number": "410-992-9921"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIRON",
"first_name": "JILL",
"middle_name": "LAUREN",
"name_prefix": "Mrs.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CO",
"license": "3014",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.