Provider Demographics
NPI:1306072095
Name:KEILING, MIRIAM BETH (LCSW)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:BETH
Last Name:KEILING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:BETH
Other - Last Name:GOLDSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:447 N EL MOLINO AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1403
Mailing Address - Country:US
Mailing Address - Phone:626-577-8480
Mailing Address - Fax:626-577-8978
Practice Address - Street 1:1940 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-2833
Practice Address - Country:US
Practice Address - Phone:619-233-3381
Practice Address - Fax:619-236-8240
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA991731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical