Provider Demographics
NPI:1487053120
Name:LIVINGSTON, MIRIAM (LCSW)
Entity type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:
Last Name:LIVINGSTON
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 1:201 E MAIN DR STE 600
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79901-1385
Mailing Address - Country:US
Mailing Address - Phone:915-877-3410
Mailing Address - Fax:
Practice Address - Street 1:2400 TRAWOOD DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4168
Practice Address - Country:US
Practice Address - Phone:915-887-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-101031041C0700X
TX662841041C0700X
NMM-08759104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
12717856OtherCAQH