Provider Demographics
NPI:1497482418
Name:MOSES, MIRANDA ANNE (MA, RMCHI)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:ANNE
Last Name:MOSES
Suffix:
Gender:F
Credentials:MA, RMCHI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 ETRUSCAN WAY
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4389
Mailing Address - Country:US
Mailing Address - Phone:321-720-6813
Mailing Address - Fax:
Practice Address - Street 1:3270 SUNTREE BLVD STE 103A
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7540
Practice Address - Country:US
Practice Address - Phone:321-757-4015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH22748101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health