Provider Demographics
NPI:1649643974
Name:MIRANDA, DAMARIS (PSYD, LMSW)
Entity type:Individual
Prefix:DR
First Name:DAMARIS
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:PSYD, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 JAMAICA AVE
Mailing Address - Street 2:ROOM 167
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-1503
Mailing Address - Country:US
Mailing Address - Phone:718-235-1087
Mailing Address - Fax:718-235-1291
Practice Address - Street 1:999 JAMAICA AVE
Practice Address - Street 2:ROOM 167
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-1503
Practice Address - Country:US
Practice Address - Phone:718-235-1087
Practice Address - Fax:718-235-1291
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035782104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker