MEDICARE: MIRANDA STONE LCSW

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
1	1041C0700X	Clinical Social Worker	149021396	IL

General Provider Information

NPI Number	:	1174167910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA STONE LCSW

Provider Business Mailing Address
First Line	:	3226 W THOMAS ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-4143
Country	:	US
Telephone Number	:	310-776-0107
Fax Number	:

Provider Business Practice Location Address
First Line	:	2539 N KEDZIE BLVD STE 4
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-1435
Country	:	US
Telephone Number	:	310-776-0107
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2019
Last Update Date	:	11/05/2019

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Directions to “ MIRANDA STONE LCSW” Practice Location

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