Individual provider Active NPI

Miriam Watson

  • Clinical Social Worker
  • Victorville, CA
National Provider Identifier
1679048813
Registry record updated Jun 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
108335 Issued in CA
Practice address
12625 Hesperia Rd
Victorville, CA 92395-7720
Phone
(760) 995-8300
NPI assigned
Oct 3, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 108335 CA Primary

Addresses

Primary practice location

12625 Hesperia Rd
Victorville, CA 92395-7720

Mailing address

12625 Hesperia Rd
Victorville, CA 92395-7720
Phone (760) 995-8300

Other names 1

  • Miriam Harrison Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
County of San Bernardino CurrentSince Jul 7, 2022 Accepting new patients
County of San Bernardino CurrentSince Jul 7, 2022 Accepting new patients
County of San Bernardino Current Accepting new patients
Soultenders, Inc. Mental Health CurrentSince May 21, 2023 Accepting new patients

Locations

41 E Foothill Blvd
Ste 102
Arcadia, CA 91006
Phone (626) 701-4249

10532 Acacia St
Ste B4
Rch Cucamonga, CA 91730
Phone (909) 325-3766

303 E Vanderbilt Way
Sn Bernrdno, CA 92415
Phone (909) 388-0801

780 E Gilbert St
Sn Bernrdno, CA 92415
Phone (909) 387-7194

12625 Hesperia Rd
Victorville, CA 92395
Phone (760) 955-1777

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1538524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655251200000",
    "number": "1679048813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12625 HESPERIA RD",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923957720",
            "telephone_number": "760-995-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12625 HESPERIA RD",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923957720",
            "telephone_number": "760-995-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATSON",
        "first_name": "MIRIAM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-03",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "108335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIRIAM",
            "last_name": "HARRISON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Victorville, CA

Sources for this page

Verify at the official NPI Registry.