Healthcare Provider Details

I. General information

NPI: 1790607042
Provider Name (Legal Business Name): ABBY MIRANDA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 MIDDLETOWN RD UNIT A
COLCHESTER CT
06415-2307
US

IV. Provider business mailing address

39 1/2 WEDGEWOOD DR STE 1028
JEWETT CITY CT
06351-2439
US

V. Phone/Fax

Practice location:
  • Phone: 860-634-4461
  • Fax:
Mailing address:
  • Phone: 860-337-4013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9972
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: