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NPI Code Detail

MEDICARE: JUAN MIRANDA MSW, LICSWA

MEDICARE: JUAN MIRANDA MSW, LICSWA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerSC61415782WA

General Provider Information

NPI Number : 1073027207
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUAN MIRANDA MSW, LICSWA
Provider Business Mailing Address
First Line : 4120 MERIDIAN ST STE 220
Second Line :
City : BELLINGHAM
State : WA
Zip : 98226-5575
Country : US
Telephone Number : 360-922-3030
Fax Number :
Provider Business Practice Location Address
First Line : 4120 MERIDIAN ST STE 220
Second Line :
City : BELLINGHAM
State : WA
Zip : 98226-5575
Country : US
Telephone Number : 360-922-3030
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/27/2017
Last Update Date : 02/29/2024

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Directions to “ JUAN MIRANDA MSW, LICSWA” Practice Location

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