Provider Demographics
NPI:1962154443
Name:HEMMAD, MILIE SHETH
Entity type:Individual
Prefix:
First Name:MILIE
Middle Name:SHETH
Last Name:HEMMAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17221 BERLIN LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4505
Mailing Address - Country:US
Mailing Address - Phone:510-541-5399
Mailing Address - Fax:
Practice Address - Street 1:17221 BERLIN LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-4505
Practice Address - Country:US
Practice Address - Phone:510-541-5399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA180101581103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool