Provider Demographics
NPI:1922330984
Name:MIRON, CHERYL A (LCSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:MIRON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5127 MUIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-2563
Mailing Address - Country:US
Mailing Address - Phone:315-329-6056
Mailing Address - Fax:315-329-6056
Practice Address - Street 1:104 JAMESVILLE RD
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:NY
Practice Address - Zip Code:13214-2245
Practice Address - Country:US
Practice Address - Phone:315-329-6056
Practice Address - Fax:315-329-6056
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0765881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical