Provider Demographics
NPI:1649621749
Name:FILAMINI, MIRANDA LANE BIVENS (LCSW, MFTA)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:LANE BIVENS
Last Name:FILAMINI
Suffix:
Gender:F
Credentials:LCSW, MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 DEER LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1216
Mailing Address - Country:US
Mailing Address - Phone:270-314-0543
Mailing Address - Fax:502-331-6062
Practice Address - Street 1:1979 RICHMOND DR STE 3
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1411
Practice Address - Country:US
Practice Address - Phone:502-230-8694
Practice Address - Fax:502-331-6062
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
KY2537691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical