Provider Demographics
NPI:1962009092
Name:CAROL MIRONES LLC
Entity Type:Organization
Organization Name:CAROL MIRONES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:LIPSCOMB
Authorized Official - Last Name:MIRONES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-342-0982
Mailing Address - Street 1:12505 ORANGE DR STE 908
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-4300
Mailing Address - Country:US
Mailing Address - Phone:954-342-0982
Mailing Address - Fax:954-342-1080
Practice Address - Street 1:12505 ORANGE DR STE 908
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4300
Practice Address - Country:US
Practice Address - Phone:954-342-0982
Practice Address - Fax:954-342-1080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty