Provider Demographics
NPI:1396075388
Name:MIRANDA, ALBA NYDIA (LCSW)
Entity type:Individual
Prefix:
First Name:ALBA
Middle Name:NYDIA
Last Name:MIRANDA
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:PO BOX 434
Mailing Address - Street 2:
Mailing Address - City:PRIMOS SECANE
Mailing Address - State:PA
Mailing Address - Zip Code:19018-0434
Mailing Address - Country:US
Mailing Address - Phone:267-471-1922
Mailing Address - Fax:
Practice Address - Street 1:400 GLENDALE RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-3152
Practice Address - Country:US
Practice Address - Phone:267-471-1922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW127479104100000X
PACW021736101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker