Provider Demographics
NPI:1861229684
Name:MIRANDA, STEPHANY M ORTIZ SR (PSYD)
Entity type:Individual
Prefix:MRS
First Name:STEPHANY M
Middle Name:ORTIZ
Last Name:MIRANDA
Suffix:SR
Gender:
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:CONCORDIA GRADENS I
Mailing Address - Street 2:12-C CALLE LIVORNA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:787-702-2434
Mailing Address - Fax:
Practice Address - Street 1:735 AVE PONCE DE LEON
Practice Address - Street 2:TORRE DE AUXILIO MUTUO STE 410
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5025
Practice Address - Country:US
Practice Address - Phone:787-704-0705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15228104100000X
PR8225103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty