Provider Demographics
NPI:1578624680
Name:LI, MIRANDA K (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:K
Last Name:LI
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Gender:F
Credentials:LCSW
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Mailing Address - Street 1:KAISER PERMANENTE
Mailing Address - Street 2:280 WEST MACARTHUR BOULEVARD
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611
Mailing Address - Country:US
Mailing Address - Phone:510-752-1473
Mailing Address - Fax:510-752-1404
Practice Address - Street 1:280 WEST MACARTHUR BOULEVARD
Practice Address - Street 2:MOSSWOOD 4TH FLOOR
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5642
Practice Address - Country:US
Practice Address - Phone:510-752-1473
Practice Address - Fax:510-752-1404
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CALCS108111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS 10811OtherLICENSED CLINICAL SW