MEDICARE: VIRGELINA MIRANDA LCSW, LSW

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	090764-01	NY
2	104100000X	Social Worker	44SL06902400	NJ

General Provider Information

NPI Number	:	1477652386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGELINA MIRANDA LCSW, LSW

Provider Business Mailing Address
First Line	:	230 W 129TH ST APT 5B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-1909
Country	:	US
Telephone Number	:	718-796-5300
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 W 129TH ST APT 5B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-1909
Country	:	US
Telephone Number	:	718-796-5300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	04/30/2024

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