Provider Demographics
NPI:1528681137
Name:MIRONES, CAROL L
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:MIRONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 E OAKLAND PARK BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1658
Mailing Address - Country:US
Mailing Address - Phone:954-342-0982
Mailing Address - Fax:954-342-0180
Practice Address - Street 1:2601 E OAKLAND PARK BLVD STE 205
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1658
Practice Address - Country:US
Practice Address - Phone:954-342-0982
Practice Address - Fax:954-342-0180
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-19
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108817000Medicaid