Provider Demographics
NPI:1629232426
Name:MINER, KIRAN P (LCSWR)
Entity Type:Individual
Prefix:MRS
First Name:KIRAN
Middle Name:P
Last Name:MINER
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:PROF
Other - First Name:KIRAN
Other - Middle Name:P
Other - Last Name:MINER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:265 STEEP HILL RD
Mailing Address - Street 2:
Mailing Address - City:BEACH LAKE
Mailing Address - State:PA
Mailing Address - Zip Code:18405-4004
Mailing Address - Country:US
Mailing Address - Phone:845-649-7280
Mailing Address - Fax:
Practice Address - Street 1:3 COATES DR STE 8
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6765
Practice Address - Country:US
Practice Address - Phone:845-291-0999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR073142-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical