Provider Demographics
NPI:1295053965
Name:MIRANDA, LINDA S (MPSY)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:S
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:MPSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8076
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-8076
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:COND SANTA JUANA # II
Practice Address - Street 2:STREET 15 N22
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-2107
Practice Address - Country:US
Practice Address - Phone:787-225-2063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3383103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist