Provider Demographics
NPI:1689306441
Name:MIRANDA, CLARE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CLARE
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:CLARE
Other - Middle Name:
Other - Last Name:CRISCUOLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:11 HUGHES ST
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-2614
Mailing Address - Country:US
Mailing Address - Phone:203-464-3688
Mailing Address - Fax:
Practice Address - Street 1:11 HUGHES ST
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-2614
Practice Address - Country:US
Practice Address - Phone:203-464-3688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5609101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional