Provider Demographics
NPI:1447338363
Name:ZICHT, MIRIAM SARAH (PHD)
Entity type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:SARAH
Last Name:ZICHT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36362 US HIGHWAY 19 NORTH
Mailing Address - Street 2:SEIN PROFESSIONAL CENTER
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684
Mailing Address - Country:US
Mailing Address - Phone:727-787-6177
Mailing Address - Fax:727-787-8066
Practice Address - Street 1:36362 US HIGHWAY 19 N
Practice Address - Street 2:SEIN PROFESSIONAL CENTER
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1328
Practice Address - Country:US
Practice Address - Phone:727-787-6177
Practice Address - Fax:727-787-8066
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5554103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54832OtherBC/BS
FL54832OtherBC/BS