Provider Demographics
NPI:1235359746
Name:MIRANDA, YOLANDA (MA)
Entity Type:Individual
Prefix:MRS
First Name:YOLANDA
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2488
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-2488
Mailing Address - Country:US
Mailing Address - Phone:787-647-7552
Mailing Address - Fax:787-701-5726
Practice Address - Street 1:46 CALLE PADIAL
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3555
Practice Address - Country:US
Practice Address - Phone:787-745-2364
Practice Address - Fax:787-286-8385
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2191103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling