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General NPI Number Information
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NPI Number | 1386281103
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Entity Type | Individual
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Provider Name | MIRANDA AARON LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/01/2019
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Last Update Date | 12/01/2019
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Provider Practice Location Address
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Address Line | 76 S ORANGE AVE STE 206B
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-1923
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Country | US
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Telephone | 973-762-9296
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Fax |
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Provider Business Mailing Address
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Address Line | 492 PROSPECT ST
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City | MAPLEWOOD
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State | NJ
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Zip | 07040-1304
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Country | US
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Telephone | 917-699-7482
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SC05250100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 44SC05250200
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License Number State | NJ
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