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NPI Code Detail

MEDICARE: MARIANA VALENTINA MIRASOLO

MEDICARE: MARIANA VALENTINA MIRASOLO
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
1101YM0800XMental Health Counselor302101KY

General Provider Information

NPI Number : 1174496566
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIANA VALENTINA MIRASOLO
Provider Business Mailing Address
First Line : 2801 JEFFERSON ST APT 49
Second Line :
City : PADUCAH
State : KY
Zip : 42001-4162
Country : US
Telephone Number : 339-222-8101
Fax Number :
Provider Business Practice Location Address
First Line : 2500 HOLT RD
Second Line :
City : PADUCAH
State : KY
Zip : 42001-8661
Country : US
Telephone Number : 270-713-8121
Fax Number : 270-212-6086
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2025
Last Update Date : 03/31/2026

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Directions to “ MARIANA VALENTINA MIRASOLO ” Practice Location

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