Provider Demographics
NPI:1619246303
Name:MIRANDA, DEBBIE ANN (BCBA)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:ANN
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:ANN
Other - Last Name:CLAUDIO-LEBRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1650 ASHBURY LN
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-4887
Mailing Address - Country:US
Mailing Address - Phone:815-999-1524
Mailing Address - Fax:
Practice Address - Street 1:1650 ASHBURY LN
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-4887
Practice Address - Country:US
Practice Address - Phone:815-999-1524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-25
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 106S00000X
1-19-36060103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician