Provider Demographics
NPI:1023595329
Name:LANDAU, MIRIAM (PCC)
Entity type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:
Last Name:LANDAU
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-5030
Mailing Address - Country:US
Mailing Address - Phone:330-701-9111
Mailing Address - Fax:866-968-3335
Practice Address - Street 1:400 MEADOW LN
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-5030
Practice Address - Country:US
Practice Address - Phone:330-701-9111
Practice Address - Fax:866-968-3335
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0003663101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1710281001OtherNPI 2