MEDICARE: PANORAMA THERAPY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103TC1900X	Counseling Psychologist
2	101Y00000X	Counselor
3	103TC0700X	Clinical Psychologist
4	1041C0700X	Clinical Social Worker
5	103T00000X	Psychologist

General Provider Information

NPI Number	:	1477141695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PANORAMA THERAPY PLLC

Provider Business Mailing Address
First Line	:	1606 HEADWAY CIR STE 9538
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78754-5123
Country	:	US
Telephone Number	:	512-354-4615
Fax Number	:

Provider Business Practice Location Address
First Line	:	4617 BROADWAY
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-6504
Country	:	US
Telephone Number	:	512-354-4615
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MIRANDA MEI NADEAU
Credential	:	PHD
Telephone Number	:	512-354-4615

Provider Enumeration Date	:	01/04/2021
Last Update Date	:	08/14/2024

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