Provider Demographics
NPI:1952074353
Name:MILANA, MIRANDA (PSYD)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:MILANA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WRENTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02093-1752
Mailing Address - Country:US
Mailing Address - Phone:207-314-3909
Mailing Address - Fax:
Practice Address - Street 1:55 CHAPEL ST STE 202
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1072
Practice Address - Country:US
Practice Address - Phone:617-658-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11498103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist