Provider Demographics
NPI:1891913224
Name:MIRANDA-EVANS, VALETTA LEE (MSW)
Entity Type:Individual
Prefix:
First Name:VALETTA
Middle Name:LEE
Last Name:MIRANDA-EVANS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 BRILL CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-3448
Mailing Address - Country:US
Mailing Address - Phone:302-723-1677
Mailing Address - Fax:
Practice Address - Street 1:62 N CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-2238
Practice Address - Country:US
Practice Address - Phone:302-723-1677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ100007601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical