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NPI Code Detail

MEDICARE: MIRANDA DEGEN

MEDICARE: MIRANDA DEGEN
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 CounselorMA

General Provider Information

NPI Number : 1457202608
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRANDA DEGEN
Provider Business Mailing Address
First Line : 68 VERNON ST
Second Line :
City : WAKEFIELD
State : MA
Zip : 01880-1958
Country : US
Telephone Number : 351-235-0854
Fax Number :
Provider Business Practice Location Address
First Line : 110 BOSTON ST
Second Line :
City : SALEM
State : MA
Zip : 01970-1402
Country : US
Telephone Number : 351-235-0854
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2026
Last Update Date : 02/04/2026

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Directions to “ MIRANDA DEGEN ” Practice Location

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