Provider Demographics
NPI:1720249212
Name:MIRMIRAN, HANNAH G (LCSW, LMHP)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:G
Last Name:MIRMIRAN
Suffix:
Gender:F
Credentials:LCSW, LMHP
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:G
Other - Last Name:ESKRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6901 DODGE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-2759
Mailing Address - Country:US
Mailing Address - Phone:402-595-8368
Mailing Address - Fax:402-939-0059
Practice Address - Street 1:6901 DODGE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-2759
Practice Address - Country:US
Practice Address - Phone:402-595-8368
Practice Address - Fax:402-939-0059
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE36511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE600514021Medicaid