MEDICARE: MIRANDA DOUGOUD MSW, 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	1041C0700X	Clinical Social Worker		KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790278000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA DOUGOUD MSW, LCSW

Provider Business Mailing Address
First Line	:	501 DARBY CREEK RD STE 40
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1671
Country	:	US
Telephone Number	:	859-287-4646
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 DARBY CREEK RD STE 40
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1671
Country	:	US
Telephone Number	:	859-287-4646
Fax Number	:

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

Provider Enumeration Date	:	06/11/2018
Last Update Date	:	03/30/2026

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