Provider Demographics
NPI:1588326946
Name:MACHADO, MIRYAN YSABEL
Entity type:Individual
Prefix:
First Name:MIRYAN
Middle Name:YSABEL
Last Name:MACHADO
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 1:13925 PLEASANT GROVE CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1166
Mailing Address - Country:US
Mailing Address - Phone:301-792-9094
Mailing Address - Fax:
Practice Address - Street 1:13925 PLEASANT GROVE CT
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1166
Practice Address - Country:US
Practice Address - Phone:301-792-9094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD160501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical