Provider Demographics
NPI:1487299624
Name:MIRIAM CENTER FOR HOPE AND HEALING LLP
Entity type:Organization
Organization Name:MIRIAM CENTER FOR HOPE AND HEALING LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PLONKA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:716-373-6735
Mailing Address - Street 1:112 SOUTH CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760
Mailing Address - Country:US
Mailing Address - Phone:716-313-6735
Mailing Address - Fax:888-622-1235
Practice Address - Street 1:112 SOUTH CLINTON ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760
Practice Address - Country:US
Practice Address - Phone:716-313-6735
Practice Address - Fax:888-622-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty