Provider Demographics
NPI:1376948943
Name:MIRANDA COMMUNICATION
Entity Type:Organization
Organization Name:MIRANDA COMMUNICATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR SOCIAL WORK
Authorized Official - Prefix:MS
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:BEAN
Authorized Official - Last Name:BEAUJON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-378-0253
Mailing Address - Street 1:5205 ORDSALL PL
Mailing Address - Street 2:VA BEACH, VA
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6884
Mailing Address - Country:US
Mailing Address - Phone:917-378-0253
Mailing Address - Fax:
Practice Address - Street 1:5205 ORDSALL PL
Practice Address - Street 2:VA BEACH, VA
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6884
Practice Address - Country:US
Practice Address - Phone:917-378-0253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-25
Last Update Date:2014-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040084511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty