Provider Demographics
NPI:1154735579
Name:KNIGHT HIMES, MIRANDA MARYAN (LCSW-R)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:MARYAN
Last Name:KNIGHT HIMES
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:MARYAN
Other - Last Name:HIMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:237 EATON CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:DELANSON
Mailing Address - State:NY
Mailing Address - Zip Code:12053-4901
Mailing Address - Country:US
Mailing Address - Phone:518-207-6310
Mailing Address - Fax:
Practice Address - Street 1:40 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-1481
Practice Address - Country:US
Practice Address - Phone:518-207-6310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0831791041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool