Provider Demographics
NPI:1104632918
Name:MALONEY, MIRANDA C
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:C
Last Name:MALONEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6250
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-0250
Mailing Address - Country:US
Mailing Address - Phone:888-238-1818
Mailing Address - Fax:855-915-1521
Practice Address - Street 1:600 LIBERTY LN
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-9432
Practice Address - Country:US
Practice Address - Phone:405-548-1029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24-397391106S00000X
OK106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician