Individual
DR. MIRIAM S. DERISO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
321 S LANG AVE, PITTSBURGH, PA 15208-2749
(412) 371-8899
Mailing address
321 S LANG AVE, PITTSBURGH, PA 15208-2749
(412) 371-8899
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS007137L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014487710001
—
PA
Enumeration date
07/26/2005
Last updated
07/18/2016
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