| Doctor Name: | MIRANDA BOE |
| NPI Number: | 1033589239 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSYD |
| License Number: | 3137 |
| Business Practice Address: | 14722 Addison St Sherman Oaks, CA - 914031634 |
| Business Phone Number: | 4152186528 |
| Business Fax Number: | |
| Mailing Address: | 14722 Addison St, SHERMAN OAKS |
| State: | CA |
| Postal Code: | 914031634 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/30/2015 |
| NPI Last Update Date: | 09/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | 3137 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |