Healthcare Provider Details

I. General information

NPI: 1497363105
Provider Name (Legal Business Name): MIRANDA ICART PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BALD HILL RD
WARWICK RI
02886-1617
US

IV. Provider business mailing address

76 WEBB AVE
WARWICK RI
02889-4628
US

V. Phone/Fax

Practice location:
  • Phone: 401-349-3131
  • Fax: 401-921-5109
Mailing address:
  • Phone: 401-529-3336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS01871
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: