Provider Demographics
NPI:1225078041
Name:VORAN, MIRIAM JUDITH (PHD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:JUDITH
Last Name:VORAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CRAFTS AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03784-1105
Mailing Address - Country:US
Mailing Address - Phone:603-298-5485
Mailing Address - Fax:
Practice Address - Street 1:79 MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-2955
Practice Address - Country:US
Practice Address - Phone:802-223-2134
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0480000655103TC0700X
NH798103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2194Medicaid
VT06239108OtherBLUECROSS AND BLUE SHIELD
VTOVN2194Medicaid
S99718Medicare UPIN