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General NPI Number Information
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NPI Number | 1073320362
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Entity Type | Individual
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Provider Name | MIRANDA M JUAREZ LMSW
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Gender | Female
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Dates
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Enumeration Date | 12/11/2024
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 595 ASHLEY CT STE 5
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City | NORTH LIBERTY
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State | IA
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Zip | 52317-4758
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Country | US
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Telephone | 319-853-8762
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Fax | 319-249-6875
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Provider Business Mailing Address
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Address Line | 3251 REDHAWK ST APT 312
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City | CORALVILLE
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State | IA
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Zip | 52241-8540
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Country | US
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Telephone | 630-248-1669
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Fax | 319-249-6875
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 108278
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License Number State | IA
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