Provider Demographics
NPI:1487990412
Name:ROBB, MIRIAM (MFT)
Entity type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:
Last Name:ROBB
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:
Other - Last Name:BARSOUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:81 ABBEYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2907
Mailing Address - Country:US
Mailing Address - Phone:949-942-3207
Mailing Address - Fax:
Practice Address - Street 1:81 ABBEYWOOD LN
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-2907
Practice Address - Country:US
Practice Address - Phone:949-942-3207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51337106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist