Provider Demographics
NPI:1811227671
Name:MICHAEL D. MIRAN, PH.D. PSYCHOLOGIST P.C.
Entity Type:Organization
Organization Name:MICHAEL D. MIRAN, PH.D. PSYCHOLOGIST P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:MIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:585-473-3558
Mailing Address - Street 1:272 SYLVAN RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-1342
Mailing Address - Country:US
Mailing Address - Phone:585-473-3558
Mailing Address - Fax:
Practice Address - Street 1:272 SYLVAN RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-1342
Practice Address - Country:US
Practice Address - Phone:585-473-3558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005412-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11524 (A)Medicare PIN