MEDICARE: MIRANDA LANE BIVENS FILAMINI LCSW, MFTA

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
2	1041C0700X	Clinical Social Worker	253769	KY

General Provider Information

NPI Number	:	1649621749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA LANE BIVENS FILAMINI LCSW, MFTA

Provider Business Mailing Address
First Line	:	1630 DEER LN
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40205-1216
Country	:	US
Telephone Number	:	270-314-0543
Fax Number	:	502-331-6062

Provider Business Practice Location Address
First Line	:	1979 RICHMOND DR STE 3
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40205-1411
Country	:	US
Telephone Number	:	502-230-8694
Fax Number	:	502-331-6062

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

Provider Enumeration Date	:	06/29/2016
Last Update Date	:	03/24/2021

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