Provider Demographics
NPI:1508405192
Name:SIDAROS, MIRANDE S
Entity Type:Individual
Prefix:
First Name:MIRANDE
Middle Name:S
Last Name:SIDAROS
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 1:10 SERENADE PARK
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-2758
Mailing Address - Country:US
Mailing Address - Phone:508-294-0427
Mailing Address - Fax:508-230-9840
Practice Address - Street 1:10 SERENADE PARK
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-2758
Practice Address - Country:US
Practice Address - Phone:508-294-0427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health