Provider Demographics
NPI:1710463385
Name:MARIPOSA THERAPY & ASSESSMENT, PLLC
Entity Type:Organization
Organization Name:MARIPOSA THERAPY & ASSESSMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:206-486-2656
Mailing Address - Street 1:5225 WISCONSIN AVE NW STE 513
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2024
Mailing Address - Country:US
Mailing Address - Phone:206-486-2656
Mailing Address - Fax:202-364-0561
Practice Address - Street 1:5225 WISCONSIN AVE NW STE 513
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2024
Practice Address - Country:US
Practice Address - Phone:206-486-2656
Practice Address - Fax:202-364-0561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-17
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60498191103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty