Provider Demographics
NPI:1568021392
Name:MIRANDA, MAYOLA (LCSW)
Entity Type:Individual
Prefix:DR
First Name:MAYOLA
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6884
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-6884
Mailing Address - Country:US
Mailing Address - Phone:760-509-2360
Mailing Address - Fax:855-706-2058
Practice Address - Street 1:2204 S EL CAMINO REAL STE 305
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6306
Practice Address - Country:US
Practice Address - Phone:619-763-8945
Practice Address - Fax:855-706-2058
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW248991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical