MEDICARE: DR. DAMARIS MIRANDA PSYD, LMSW

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	104100000X	Social Worker	035782	NY

General Provider Information

NPI Number	:	1649643974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAMARIS MIRANDA PSYD, LMSW

Provider Business Mailing Address
First Line	:	999 JAMAICA AVE
Second Line	:	ROOM 167
City	:	BROOKLYN
State	:	NY
Zip	:	11208-1503
Country	:	US
Telephone Number	:	718-235-1087
Fax Number	:	718-235-1291

Provider Business Practice Location Address
First Line	:	999 JAMAICA AVE
Second Line	:	ROOM 167
City	:	BROOKLYN
State	:	NY
Zip	:	11208-1503
Country	:	US
Telephone Number	:	718-235-1087
Fax Number	:	718-235-1291

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

Provider Enumeration Date	:	11/09/2015
Last Update Date	:	11/09/2015

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