Provider Demographics
NPI:1003940917
Name:MIRANTE, PAMELA ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ELIZABETH
Last Name:MIRANTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 W SHORE AVE
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-8942
Mailing Address - Country:US
Mailing Address - Phone:860-916-3272
Mailing Address - Fax:
Practice Address - Street 1:808 STONINGTON RD STE 200
Practice Address - Street 2:
Practice Address - City:STONINGTON
Practice Address - State:CT
Practice Address - Zip Code:06378-2517
Practice Address - Country:US
Practice Address - Phone:860-204-6589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0049171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical