MEDICARE: MIRANDA SIMUNIC LCSW

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	SW126794	PA
2	1041C0700X	Clinical Social Worker	CW017137	PA

General Provider Information

NPI Number	:	1700182656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA SIMUNIC LCSW

Provider Business Mailing Address
First Line	:	303 BUDFIELD ST
Second Line	:
City	:	JOHNSTOWN
State	:	PA
Zip	:	15904-3213
Country	:	US
Telephone Number	:	814-266-3196
Fax Number	:	814-266-6296

Provider Business Practice Location Address
First Line	:	303 BUDFIELD ST
Second Line	:
City	:	JOHNSTOWN
State	:	PA
Zip	:	15904-3213
Country	:	US
Telephone Number	:	814-266-3196
Fax Number	:	814-266-6296

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

Provider Enumeration Date	:	02/09/2011
Last Update Date	:	11/17/2023

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Directions to “ MIRANDA SIMUNIC LCSW” Practice Location

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