Active NPI
Miriam Monique Deberry, LMFT
- Marriage & Family Therapist
- Los Angeles, CA
National Provider Identifier
1417614579
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 123881
- Practice address
- 4470 W Sunset Blvd Ste 107
Los Angeles, CA 90027-6309 - Phone
- (323) 701-0371
- NPI assigned
- Nov 23, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 2014006569 | MO | |
| Marriage & Family Therapist | 106H00000X | 123881 | CA | Primary |
Addresses
Primary practice location
4470 W Sunset Blvd Ste 107
Los Angeles, CA 90027-6309
Mailing address
PO Box 33023
San Diego, CA 92163-2023
Phone (619) 343-2889
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2014006569 | Other | MO | MO LMFT# |
| 123881 | Other | CA | CA LMFT# |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | SANDIEGO | Direct |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 123881 | CA | MD | Marriage & Family Therapist |
| 2014006569 | MO | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1637625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704931200000",
"number": "1417614579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 33023",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921632023",
"telephone_number": "619-343-2889"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4470 W SUNSET BLVD STE 107",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900276309",
"telephone_number": "323-701-0371"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEBERRY",
"first_name": "MIRIAM",
"middle_name": "MONIQUE",
"name_prefix": "Ms.",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-11-23",
"last_updated": "2024-01-11",
"certification_date": "2024-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "MO",
"license": "2014006569",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "123881",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MO LMFT#",
"identifier": "2014006569",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CA LMFT#",
"identifier": "123881",
"state": "CA"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "SANDIEGO",
"affiliation": "N",
"endpointDescription": "workclients",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "3911 Cleveland Ave # 33023",
"city": "San Diego",
"state": "CA",
"country_code": "US",
"postal_code": "921033402",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.