Provider Demographics
NPI:1093890527
Name:MIRO, MAYRA M (PSYD)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:M
Last Name:MIRO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 SIDONIA AVE
Mailing Address - Street 2:APT. 3
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3438
Mailing Address - Country:US
Mailing Address - Phone:305-807-9119
Mailing Address - Fax:305-445-9045
Practice Address - Street 1:11401 SW 40TH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3372
Practice Address - Country:US
Practice Address - Phone:305-807-9119
Practice Address - Fax:305-445-9045
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPY 7369103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical