Healthcare Provider Details

I. General information

NPI: 1477141695
Provider Name (Legal Business Name): PANORAMA THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4617 BROADWAY
UNION CITY NJ
07087-6504
US

IV. Provider business mailing address

1606 HEADWAY CIR STE 9538
AUSTIN TX
78754-5123
US

V. Phone/Fax

Practice location:
  • Phone: 512-354-4615
  • Fax:
Mailing address:
  • Phone: 512-354-4615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. MIRANDA MEI NADEAU
Title or Position: OWNER
Credential: PHD
Phone: 512-354-4615