Miriam Bermudez, MFT
Individual provider Active NPI Marriage & Family Therapist · San Marino, CA
NPI 1740443233 · NPPES record last updated Jan 12, 2017
Key facts
- NPI
- 1740443233
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 45636 (CA)
- Practice address
- 2459 Mission St
San Marino, CA 91108-1635 - Phone
- (626) 252-7964
- NPI assigned
- Jul 6, 2008
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 45636 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| El Molino Family Therapy | Marriage & Family Therapist | Current | Accepting new patients |
Locations
1401 Fair Oaks Ave
South Pasadena, CA 91030
Phone (626) 252-4941
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 45636 | CA | Yes |
Addresses
Primary practice location
2459 Mission St
San Marino, CA 91108-1635
Mailing address
2459 Mission St
San Marino, CA 91108-1560
Phone (626) 252-7964
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All providers in San Marino, CA · Marriage & Family Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 12, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.