Provider Demographics
NPI:1871776161
Name:JUNG, MIRANDA HOFFMAN (PSYD)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:HOFFMAN
Last Name:JUNG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 WARD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1146
Mailing Address - Country:US
Mailing Address - Phone:510-917-5419
Mailing Address - Fax:949-553-6709
Practice Address - Street 1:2340 WARD ST STE 101
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705
Practice Address - Country:US
Practice Address - Phone:510-917-5419
Practice Address - Fax:949-553-6709
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19370103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical