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NPI Code Detail

MEDICARE: MRS. MIRANDA JILL STAPLETON LCSW

MEDICARE:  MRS. MIRANDA JILL STAPLETON  LCSW
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
1104100000XSocial WorkerMSW002687GA
21041C0700XClinical Social WorkerCSW004757GA

General Provider Information

NPI Number : 1811154255
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MIRANDA JILL STAPLETON LCSW
Provider Business Mailing Address
First Line : 116 PIERCE AVE
Second Line :
City : MACON
State : GA
Zip : 31204-2891
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 116 PIERCE AVE
Second Line :
City : MACON
State : GA
Zip : 31204-2891
Country : US
Telephone Number : 478-464-3010
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2008
Last Update Date : 03/18/2015

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Directions to “ MRS. MIRANDA JILL STAPLETON LCSW” Practice Location

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