Provider Demographics
NPI:1942488283
Name:MIRON, LOWELL S (MA PSYCHOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:LOWELL
Middle Name:S
Last Name:MIRON
Suffix:
Gender:M
Credentials:MA PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2329 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4831
Mailing Address - Country:US
Mailing Address - Phone:718-769-4901
Mailing Address - Fax:
Practice Address - Street 1:2329 E 22ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4831
Practice Address - Country:US
Practice Address - Phone:718-769-4901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities