Provider Demographics
NPI:1790260826
Name:MIRANDA, SARA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 MILL ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02122-3500
Mailing Address - Country:US
Mailing Address - Phone:617-926-5480
Mailing Address - Fax:617-926-3059
Practice Address - Street 1:71 ARSENAL ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2638
Practice Address - Country:US
Practice Address - Phone:617-926-5480
Practice Address - Fax:617-926-3059
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101531211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical