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General NPI Number Information
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NPI Number | 1457060535
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Entity Type | Individual
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Provider Name | ANA LAURA MIRANDA
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Gender | Female
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Dates
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Enumeration Date | 11/17/2022
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Last Update Date | 11/17/2022
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Provider Practice Location Address
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Address Line | 98120 QUEENS BLVD STE 1C
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City | REGO PARK
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State | NY
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Zip | 11374-4414
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Country | US
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Telephone | 631-903-9250
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Fax |
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Provider Business Mailing Address
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Address Line | 6573 EMERALD DUNES DR APT 303
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City | WEST PALM BEACH
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State | FL
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Zip | 33411-2775
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Country | US
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Telephone | 631-903-9250
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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 | 012787-01
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License Number State | NY
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