Provider Demographics
NPI:1922724384
Name:MIRANDA CALDERON, MARIELIS (MHC)
Entity Type:Individual
Prefix:
First Name:MARIELIS
Middle Name:
Last Name:MIRANDA CALDERON
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CAMBRIDGE ST FL 14
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2509
Mailing Address - Country:US
Mailing Address - Phone:617-861-4958
Mailing Address - Fax:833-642-0620
Practice Address - Street 1:100 CAMBRIDGE ST FL 14
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2509
Practice Address - Country:US
Practice Address - Phone:617-861-4958
Practice Address - Fax:833-642-0620
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty