MEDICARE: MRS. MIRANDA JENKINS MSW, LSW

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	SW134714	PA

General Provider Information

NPI Number	:	1730978941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MIRANDA JENKINS MSW, LSW

Provider Business Mailing Address
First Line	:	65 CARDINAL DR
Second Line	:
City	:	HANOVER
State	:	PA
Zip	:	17331-9789
Country	:	US
Telephone Number	:	717-880-2619
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 CARLISLE ST STE 205
Second Line	:
City	:	HANOVER
State	:	PA
Zip	:	17331-2472
Country	:	US
Telephone Number	:	717-819-9818
Fax Number	:

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

Provider Enumeration Date	:	05/05/2025
Last Update Date	:	05/05/2025

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