Provider Demographics
NPI:1972995173
Name:MIRANDA, VANDA BARBOSA
Entity Type:Individual
Prefix:MRS
First Name:VANDA
Middle Name:BARBOSA
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:VANDA
Other - Middle Name:BARBOSA
Other - Last Name:MIRANDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:36 FRANCES ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1408
Mailing Address - Country:US
Mailing Address - Phone:774-444-9084
Mailing Address - Fax:
Practice Address - Street 1:44 DIAUTO DR
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-4536
Practice Address - Country:US
Practice Address - Phone:781-885-7252
Practice Address - Fax:781-885-7256
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker