MEDICARE: BRIANA BENN-MIRANDI LPC

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	101YP2500X	Professional Counselor	003496	CT

General Provider Information

NPI Number	:	1497231757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANA BENN-MIRANDI LPC

Provider Business Mailing Address
First Line	:	246 DURHAM RD
Second Line	:
City	:	MADISON
State	:	CT
Zip	:	06443-2454
Country	:	US
Telephone Number	:	203-350-3717
Fax Number	:

Provider Business Practice Location Address
First Line	:	149 DURHAM RD STE 26
Second Line	:
City	:	MADISON
State	:	CT
Zip	:	06443-2664
Country	:	US
Telephone Number	:	203-350-3717
Fax Number	:

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

Provider Enumeration Date	:	07/18/2018
Last Update Date	:	07/18/2018

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