Healthcare Provider Details

I. General information

NPI: 1154735579
Provider Name (Legal Business Name): MIRANDA MARYAN KNIGHT HIMES LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MIRANDA MARYAN HIMES LCSW-R

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 EATON CORNERS RD
DELANSON NY
12053-4901
US

IV. Provider business mailing address

237 EATON CORNERS RD
DELANSON NY
12053-4901
US

V. Phone/Fax

Practice location:
  • Phone: 518-207-6310
  • Fax:
Mailing address:
  • Phone: 518-207-6310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number083179
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number083179
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: