Provider Demographics
NPI:1295340115
Name:MIRANDA, MORIAH DAWN (LCSW)
Entity type:Individual
Prefix:
First Name:MORIAH
Middle Name:DAWN
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:LCSW
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 7
Mailing Address - Street 2:
Mailing Address - City:CARLOTTA
Mailing Address - State:CA
Mailing Address - Zip Code:95528-0007
Mailing Address - Country:US
Mailing Address - Phone:707-768-3860
Mailing Address - Fax:
Practice Address - Street 1:300 WILDER ROAD
Practice Address - Street 2:
Practice Address - City:CARLOTTA
Practice Address - State:CA
Practice Address - Zip Code:95528
Practice Address - Country:US
Practice Address - Phone:707-768-3860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA946401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical