Provider Demographics
NPI:1205356797
Name:MIRANDA QUILES, JOSUE SR (LICSW)
Entity Type:Individual
Prefix:
First Name:JOSUE
Middle Name:
Last Name:MIRANDA QUILES
Suffix:SR
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 HAVELOCK RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-2543
Mailing Address - Country:US
Mailing Address - Phone:508-723-3341
Mailing Address - Fax:
Practice Address - Street 1:255 PARK AVE STE 500
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1958
Practice Address - Country:US
Practice Address - Phone:508-753-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker