Provider Demographics
NPI:1982230561
Name:SANCHEZ, MIRANDA NICOLE
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:NICOLE
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 RALPH AVE APT 2R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-4004
Mailing Address - Country:US
Mailing Address - Phone:845-325-7947
Mailing Address - Fax:
Practice Address - Street 1:89 RALPH AVE APT 2R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-4004
Practice Address - Country:US
Practice Address - Phone:845-325-7947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker