Provider Demographics
NPI:1720161045
Name:MIRANDA, VILMA ALICIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:VILMA
Middle Name:ALICIA
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 1:239 E MOSHOLU PKWY NORTH APT #4H
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467
Mailing Address - Country:US
Mailing Address - Phone:718-405-0765
Mailing Address - Fax:718-405-0765
Practice Address - Street 1:2064 BOSTON RD
Practice Address - Street 2:VIDA GUIDANCE CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-2204
Practice Address - Country:US
Practice Address - Phone:718-364-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0681481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical