Provider Demographics
NPI:1497231757
Name:BENN-MIRANDI, BRIANA (LPC)
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:
Last Name:BENN-MIRANDI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2454
Mailing Address - Country:US
Mailing Address - Phone:203-350-3717
Mailing Address - Fax:
Practice Address - Street 1:149 DURHAM RD STE 26
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2664
Practice Address - Country:US
Practice Address - Phone:203-350-3717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003496101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional