Provider Demographics
NPI:1477298222
Name:REDMOND, MIRANDA
Entity Type:Individual
Prefix:MISS
First Name:MIRANDA
Middle Name:
Last Name:REDMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:45 N CANFIELD NILES RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2343
Mailing Address - Country:US
Mailing Address - Phone:330-642-8242
Mailing Address - Fax:330-642-8242
Practice Address - Street 1:45 N CANFIELD NILES RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2343
Practice Address - Country:US
Practice Address - Phone:330-642-8242
Practice Address - Fax:330-642-8242
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.180612171M00000X
OH180612101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator