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General NPI Number Information
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NPI Number | 1942492418
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Entity Type | Individual
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Provider Name | MICHAEL LOUIS MIRANTE PH.D., L.C.S.W., MSW
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Gender | Male
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Dates
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Enumeration Date | 08/17/2007
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Last Update Date | 07/21/2019
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Provider Practice Location Address
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Address Line | 227 S MAIN ST STE 103
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City | ELKHART
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State | IN
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Zip | 46516-3185
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Country | US
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Telephone | 574-293-2000
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Fax | 574-293-2001
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Provider Business Mailing Address
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Address Line | PO BOX 2620
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City | ELKHART
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State | IN
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Zip | 46515-2620
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Country | US
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Telephone | 574-293-2000
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Fax | 574-293-2001
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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 | SW2616
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34005408A
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License Number State | IN
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