Provider Demographics
NPI:1386170835
Name:DEL RIO QUINONES-MIRANDA, MELINDA (LCSW, CADC III, QMHP)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:DEL RIO QUINONES-MIRANDA
Suffix:
Gender:F
Credentials:LCSW, CADC III, QMHP
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:DEL RIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, CADC III, QMHP
Mailing Address - Street 1:3587 HEATHROW WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4004
Mailing Address - Country:US
Mailing Address - Phone:541-858-8170
Mailing Address - Fax:
Practice Address - Street 1:7215 SE HARNEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-8645
Practice Address - Country:US
Practice Address - Phone:503-839-0733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24-04-30104101YA0400X
101YM0800X
OR23-QMHPC-001235101YM0800X
ORL113901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health