Provider Demographics
NPI:1124540570
Name:HERBERT, MIRANDA ANN (LCSW)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:ANN
Last Name:HERBERT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 N FEDERAL HWY APT 716
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-3488
Mailing Address - Country:US
Mailing Address - Phone:954-546-2522
Mailing Address - Fax:
Practice Address - Street 1:901 RIGGINS RD APT 731
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-2204
Practice Address - Country:US
Practice Address - Phone:570-575-1121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW145941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical