Provider Demographics
NPI:1124251210
Name:BIDDELMAN-MASSIN, MIRIAM R (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:R
Last Name:BIDDELMAN-MASSIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 CENTRAL PARK W
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7631
Mailing Address - Country:US
Mailing Address - Phone:212-666-7803
Mailing Address - Fax:212-666-7803
Practice Address - Street 1:327 CENTRAL PARK W
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7631
Practice Address - Country:US
Practice Address - Phone:212-666-7803
Practice Address - Fax:212-666-7803
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO132241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical