Provider Demographics
NPI:1225659071
Name:MIRANDE, CHLOE M (LBS)
Entity Type:Individual
Prefix:MRS
First Name:CHLOE
Middle Name:M
Last Name:MIRANDE
Suffix:
Gender:F
Credentials:LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 TRENTON RD # M350
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-5674
Mailing Address - Country:US
Mailing Address - Phone:215-620-8961
Mailing Address - Fax:
Practice Address - Street 1:170 PHEASANT RUN
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1877
Practice Address - Country:US
Practice Address - Phone:215-620-8961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH004862103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist