Provider Demographics
NPI:1710326053
Name:MIRANDA, IVONNE MARIE (MA, EDM, LPC)
Entity Type:Individual
Prefix:
First Name:IVONNE
Middle Name:MARIE
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:MA, EDM, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 7TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3652
Mailing Address - Country:US
Mailing Address - Phone:646-528-3237
Mailing Address - Fax:
Practice Address - Street 1:1020 7TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3652
Practice Address - Country:US
Practice Address - Phone:646-528-3237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC14250101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional