Miriam S. Wald

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY10413 Issued in CA

Practice address

523 Hayes LN
Petaluma, CA 94952-4011

Phone

(800) 257-8715

Fax

(800) 819-1655

NPI assigned

Oct 19, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Vericare of California Medical Group

  • Clinical Psychologist
  • Paradise, CA
  • NPI 1316992829
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649352733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5062 MOROCCO DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954093605",
            "telephone_number": "707-538-7726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "523 HAYES LN",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949524011",
            "telephone_number": "800-257-8715",
            "fax_number": "800-819-1655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALD",
        "first_name": "MIRIAM",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY10413",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PSY104130",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD",
            "identifier": "680006644",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0PL104130",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vivacitas Medical Group PC
• George W Wagner Jr., D.C
• Abdul Majid Wahedi, D.D.S
• Grace Wakim, PSYD
• Ahmad Walai
• Walker Speech Therapy, Inc. (Speech and Language Services of Marin-Sonoma)
• Lori S Walker, M.A.,C.C.C.
• Mona Maxine Walker, BEHAVIOR TECHNICIAN
• Mya Walker
• Kathleen M Wall

• Clinical Psychologist in Petaluma, CA
• Providers in Petaluma, CA by specialty
• Clinical Psychologist in California

• 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.

Verify at the official NPI Registry.