Provider Demographics
NPI:1033179742
Name:QUILAN, MIRIAM (LCSWR)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:
Last Name:QUILAN
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CASALS PLACE
Mailing Address - Street 2:32K
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475
Mailing Address - Country:US
Mailing Address - Phone:917-554-0016
Mailing Address - Fax:718-379-1491
Practice Address - Street 1:120 CASALS PLACE
Practice Address - Street 2:32K
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475
Practice Address - Country:US
Practice Address - Phone:917-554-0016
Practice Address - Fax:718-379-1491
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0715201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical