Provider Demographics
NPI:1235432113
Name:NAANES, MIRA (LMHC AND LADC 1)
Entity Type:Individual
Prefix:
First Name:MIRA
Middle Name:
Last Name:NAANES
Suffix:
Gender:F
Credentials:LMHC AND LADC 1
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:YVONNE
Other - Last Name:NAANES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BFA MLA MA
Mailing Address - Street 1:93 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-2701
Mailing Address - Country:US
Mailing Address - Phone:781-662-6224
Mailing Address - Fax:781-662-6224
Practice Address - Street 1:93 LAKE AVE
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-2701
Practice Address - Country:US
Practice Address - Phone:781-662-6224
Practice Address - Fax:781-662-6224
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALADC 1 1388101YA0400X
MALMHC 1191101YM0800X
MALMHC 1191101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health