Provider Demographics
NPI:1699238121
Name:LORRAIN, MIRIAM GOLDSTEIN (PHD)
Entity type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:GOLDSTEIN
Last Name:LORRAIN
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 WEALTHY ST SE STE 290
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-2755
Mailing Address - Country:US
Mailing Address - Phone:734-274-9016
Mailing Address - Fax:
Practice Address - Street 1:1514 WEALTHY ST SE STE 290
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-2755
Practice Address - Country:US
Practice Address - Phone:734-274-9016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301018948103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical