Provider Demographics
NPI:1427920016
Name:MIRANDA, MARIAH GRACE (LCSW)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:GRACE
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 1:61 HAWES WAY
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-9176
Mailing Address - Country:US
Mailing Address - Phone:530-635-5742
Mailing Address - Fax:
Practice Address - Street 1:1175 LEWIS OAK RD
Practice Address - Street 2:
Practice Address - City:GRIDLEY
Practice Address - State:CA
Practice Address - Zip Code:95948-9306
Practice Address - Country:US
Practice Address - Phone:530-635-5742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1205571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical