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General NPI Number Information
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NPI Number | 1174496566
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Entity Type | Individual
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Provider Name | MARIANA VALENTINA MIRASOLO
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Gender | Female
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Dates
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Enumeration Date | 09/24/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 413 BROADWAY ST STE A
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City | PADUCAH
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State | KY
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Zip | 42001-0738
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Country | US
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Telephone | 270-217-5128
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Fax | 270-212-6087
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Provider Business Mailing Address
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Address Line | 2801 JEFFERSON ST APT 49
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City | PADUCAH
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State | KY
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Zip | 42001-4162
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Country | US
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Telephone | 339-222-8101
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 302101
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License Number State | KY
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