Provider Demographics
NPI:1497400774
Name:CHICUNGO MIRANDA, DEBORA CRISTINA (LMHC)
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:CRISTINA
Last Name:CHICUNGO MIRANDA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9040 ROYAL PALM BLVD APT W104
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5839
Mailing Address - Country:US
Mailing Address - Phone:520-289-4688
Mailing Address - Fax:
Practice Address - Street 1:9040 ROYAL PALM BLVD APT W104
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5839
Practice Address - Country:US
Practice Address - Phone:520-289-4688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH20363101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH20363OtherLMHC