Healthcare Provider Details

I. General information

NPI: 1942134671
Provider Name (Legal Business Name): MIRANDA PAX LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E HIGH ST
CHARLOTTESVILLE VA
22902-4857
US

IV. Provider business mailing address

1101 E HIGH ST
CHARLOTTESVILLE VA
22902-4857
US

V. Phone/Fax

Practice location:
  • Phone: 434-872-0047
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904017654
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: