Provider Demographics
NPI:1740943539
Name:MIRANDA, DAN (MS, LCADC, CCS)
Entity type:Individual
Prefix:MR
First Name:DAN
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:MS, LCADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 MATHISTOWN RD UNIT 212
Mailing Address - Street 2:
Mailing Address - City:LITTLE EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08087-4062
Mailing Address - Country:US
Mailing Address - Phone:561-676-1634
Mailing Address - Fax:
Practice Address - Street 1:240 MATHISTOWN RD UNIT 212
Practice Address - Street 2:
Practice Address - City:LITTLE EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08087-4062
Practice Address - Country:US
Practice Address - Phone:561-676-1634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00315000101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)