Provider Demographics
NPI:1851713630
Name:ECHEVARRIA, MIRIAM (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:MIRIAM
Middle Name:
Last Name:ECHEVARRIA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 MULFORD AVE APT 18L
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-4332
Mailing Address - Country:US
Mailing Address - Phone:718-320-5269
Mailing Address - Fax:
Practice Address - Street 1:1730 MULFORD AVE APT 18L
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4332
Practice Address - Country:US
Practice Address - Phone:718-320-5269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086350-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical