Healthcare Provider Details

I. General information

NPI: 1720809452
Provider Name (Legal Business Name): MIRANDA MARIE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 NIMITZVIEW DR STE 102
CINCINNATI OH
45230-4331
US

IV. Provider business mailing address

9 MCCORMICK TRL
MILFORD OH
45150-1888
US

V. Phone/Fax

Practice location:
  • Phone: 513-375-7279
  • Fax:
Mailing address:
  • Phone: 513-375-7279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2405917
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberI.2405917
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: