Provider Demographics
NPI:1679371009
Name:MIAN, MARYAM (LMSW)
Entity type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:MIAN
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16442 77TH RD APT 3
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1360
Mailing Address - Country:US
Mailing Address - Phone:347-248-0222
Mailing Address - Fax:
Practice Address - Street 1:7025 PARK DR E # A
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1951
Practice Address - Country:US
Practice Address - Phone:347-248-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2399961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical