Provider Demographics
NPI:1942532684
Name:KRASNO, MIRIAM R (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:R
Last Name:KRASNO
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 1:5522 ESTERO LOOP
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-0006
Mailing Address - Country:US
Mailing Address - Phone:847-971-4597
Mailing Address - Fax:
Practice Address - Street 1:5522 ESTERO LOOP
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-0006
Practice Address - Country:US
Practice Address - Phone:479-714-5978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW125501041C0700X, 104100000X
IL149.0150251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024471800Medicaid