Provider Demographics
NPI:1386281103
Name:AARON, MIRANDA (LCSW)
Entity type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:
Last Name:AARON
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 1:492 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-1304
Mailing Address - Country:US
Mailing Address - Phone:917-699-7482
Mailing Address - Fax:
Practice Address - Street 1:76 S ORANGE AVE STE 206B
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-1923
Practice Address - Country:US
Practice Address - Phone:973-762-9296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-01
Last Update Date:2019-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05250100104100000X
NJ44SC05250200106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SC05250100OtherSTATE
NJ44SC05250100Other44SC05250100
NJ44SC05250100OtherSELF