Provider Demographics
NPI:1548676331
Name:MIRANDA, MARTA (PSYD)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 WISCONSIN AVE NW
Mailing Address - Street 2:STE 513
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2024
Mailing Address - Country:US
Mailing Address - Phone:206-486-2656
Mailing Address - Fax:
Practice Address - Street 1:5225 WISCONSIN AVE NW
Practice Address - Street 2:STE 513
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2024
Practice Address - Country:US
Practice Address - Phone:206-486-2656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60498191103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical