| David J. Miranda, Lcsw, Pllc | |
|
720 Route 17m Middletown NY 10940-4346 | |
| (845) 320-2330 | |
| Not Available |
| Full Name | David J. Miranda, Lcsw, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 720 Route 17m, Middletown, New York |
| Authorized Official Name and Position | David J Miranda (OWNER) |
| Authorized Official Contact | 8452001101 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| David J. Miranda, Lcsw, Pllc 76 Wickham Ave Goshen NY 10924-1824 Ph: (845) 200-1101 | David J. Miranda, Lcsw, Pllc 720 Route 17m Middletown NY 10940-4346 Ph: (845) 320-2330 |
| NPI Number | 1194338129 |
|---|---|
| Provider Enumeration Date | 08/28/2020 |
| Last Update Date | 08/28/2020 |
| Certification Date | 08/28/2020 |
| Medicare PECOS PAC ID | 3971974346 |
|---|---|
| Medicare Enrollment ID | O20230123000294 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194338129 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | David Joseph Miranda |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639300825 PECOS PAC ID: 5294063376 Enrollment ID: I20190828000089 |
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