Provider Demographics
NPI:1659627412
Name:MORNINGSTAR, MIRANDA (LSW)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:MORNINGSTAR
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 WHISPER CREEK DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-7770
Mailing Address - Country:US
Mailing Address - Phone:570-522-0304
Mailing Address - Fax:570-522-0475
Practice Address - Street 1:32 WHISPER CREEK DR
Practice Address - Street 2:SUITE 7
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-7770
Practice Address - Country:US
Practice Address - Phone:570-522-0304
Practice Address - Fax:570-522-0475
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW129675104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker