Provider Demographics
NPI:1083994180
Name:KANO, MARANDA NICOLE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:MARANDA
Middle Name:NICOLE
Last Name:KANO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 LEGENDS DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-4177
Mailing Address - Country:US
Mailing Address - Phone:469-243-7842
Mailing Address - Fax:
Practice Address - Street 1:1100 W JACKSON RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-1316
Practice Address - Country:US
Practice Address - Phone:972-242-2182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX555451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical