Provider Demographics
NPI:1346876810
Name:MIRANDA, ISABEL A
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:A
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 EAST AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-3854
Mailing Address - Country:US
Mailing Address - Phone:917-645-7553
Mailing Address - Fax:
Practice Address - Street 1:315 EAST AVE APT 3
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-3854
Practice Address - Country:US
Practice Address - Phone:917-645-7553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health