Provider Demographics
NPI:1770651721
Name:MIERA, FLORENCE (LMSW)
Entity Type:Individual
Prefix:
First Name:FLORENCE
Middle Name:
Last Name:MIERA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:FLORENCE
Other - Middle Name:
Other - Last Name:MIERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW
Mailing Address - Street 1:PO BOX 2203
Mailing Address - Street 2:11 CALLE TRUJILLO
Mailing Address - City:RANCHOS DE TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87557-2203
Mailing Address - Country:US
Mailing Address - Phone:505-770-1985
Mailing Address - Fax:505-758-5298
Practice Address - Street 1:235 PASEO DEL CANON E
Practice Address - Street 2:235 PASEO DEL CANON
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6239
Practice Address - Country:US
Practice Address - Phone:505-737-6103
Practice Address - Fax:505-737-6091
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-062171041S0200X
NMI-075421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool