Provider Demographics
NPI:1477298222
Name:SMITH, MIRANDA
Entity type:Individual
Prefix:MISS
First Name:MIRANDA
Middle Name:
Last Name:SMITH
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 1:6084 ELK RD
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9730
Mailing Address - Country:US
Mailing Address - Phone:330-775-9553
Mailing Address - Fax:330-775-9553
Practice Address - Street 1:6084 ELK RD
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9730
Practice Address - Country:US
Practice Address - Phone:330-775-9553
Practice Address - Fax:330-775-9553
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.006516175T00000X
OHCDCA.185061101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)