Healthcare Provider Details

I. General information

NPI: 1720713928
Provider Name (Legal Business Name): EMILY MIRANDA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 W CHANDLER BLVD STE 118
CHANDLER AZ
85225-7536
US

IV. Provider business mailing address

1472 W GLENMERE DR
CHANDLER AZ
85224-7552
US

V. Phone/Fax

Practice location:
  • Phone: 602-888-6080
  • Fax:
Mailing address:
  • Phone: 309-472-4556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-21372
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: