Provider Demographics
NPI:1609396472
Name:MIRANDA, ROSANNE (MA)
Entity Type:Individual
Prefix:
First Name:ROSANNE
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 BARRANCA PKWY STE 305
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-8232
Mailing Address - Country:US
Mailing Address - Phone:949-292-4947
Mailing Address - Fax:949-872-2855
Practice Address - Street 1:3500 BARRANCA PKWY STE 305
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-8232
Practice Address - Country:US
Practice Address - Phone:949-292-4947
Practice Address - Fax:949-872-2855
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41068103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy