Healthcare Provider Details

I. General information

NPI: 1124793443
Provider Name (Legal Business Name): MIRIAM CHARLES-FLORES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 MAIN ST
DANIELSON CT
06239-2816
US

IV. Provider business mailing address

227 MAIN ST
DANIELSON CT
06239-2816
US

V. Phone/Fax

Practice location:
  • Phone: 401-578-9411
  • Fax: 860-831-1140
Mailing address:
  • Phone: 401-578-9411
  • Fax: 860-831-1140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number004928
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: