Provider Demographics
NPI:1437870870
Name:MIRANDA HEALING GROUP
Entity Type:Organization
Organization Name:MIRANDA HEALING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, PHD
Authorized Official - Phone:201-820-5422
Mailing Address - Street 1:4885 NW 94TH TER
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-5149
Mailing Address - Country:US
Mailing Address - Phone:201-820-5422
Mailing Address - Fax:954-278-8506
Practice Address - Street 1:7301 N UNIVERSITY DR STE 209
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2935
Practice Address - Country:US
Practice Address - Phone:954-840-8583
Practice Address - Fax:954-278-8506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty