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General NPI Number Information
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NPI Number | 1477141695
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Entity Type | Organization
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Legal Business Name | PANORAMA THERAPY PLLC
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Dates
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Enumeration Date | 01/04/2021
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 4617 BROADWAY
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City | UNION CITY
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State | NJ
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Zip | 07087-6504
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Country | US
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Telephone | 512-354-4615
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Fax |
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Provider Business Mailing Address
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Address Line | 1606 HEADWAY CIR STE 9538
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City | AUSTIN
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State | TX
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Zip | 78754-5123
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Country | US
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Telephone | 512-354-4615
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MIRANDA MEI NADEAU
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Credential | PHD
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Telephone | 512-354-4615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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