Provider Demographics
NPI:1831647338
Name:HUGHES, MIRANDA LEIGH
Entity Type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:LEIGH
Last Name:HUGHES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 WASHINGTON ST STE 209201
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3688
Mailing Address - Country:US
Mailing Address - Phone:203-244-8300
Mailing Address - Fax:978-584-7857
Practice Address - Street 1:201 WASHINGTON ST STE 209
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3617
Practice Address - Country:US
Practice Address - Phone:203-244-8300
Practice Address - Fax:978-584-7857
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1946106H00000X
MA1928106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist