Provider Demographics
NPI:1205199775
Name:DESOUZA MIRANDA, LIANA PAULA
Entity Type:Individual
Prefix:
First Name:LIANA
Middle Name:PAULA
Last Name:DESOUZA MIRANDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIANA
Other - Middle Name:PAULA
Other - Last Name:DESOUZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2701 EMMONS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2209
Mailing Address - Country:US
Mailing Address - Phone:718-368-6291
Mailing Address - Fax:718-368-6290
Practice Address - Street 1:2701 EMMONS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2209
Practice Address - Country:US
Practice Address - Phone:718-368-6291
Practice Address - Fax:718-368-6290
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator