| Doctor Name: | DR. MIRIAM JOHN |
| NPI Number: | 1245220169 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 4441 |
| Business Practice Address: | 2 Washington Sq Apt 6a Larchmont, NY - 105382019 |
| Business Phone Number: | 9148331125 |
| Business Fax Number: | 9148337873 |
| Mailing Address: | 2 Washington Sq Apt 6a, LARCHMONT |
| State: | NY |
| Postal Code: | 105382019 |
| Phone Number: | 9148331125 |
| Fax Number: | 9148337873 |
| NPI Enumeration Date: | 10/22/2005 |
| NPI Last Update Date: | 06/02/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 4441 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |