Provider Demographics
NPI:1992809313
Name:SMITH, MIRANDA FELICE (MSW)
Entity type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:FELICE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25975 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3142
Mailing Address - Country:US
Mailing Address - Phone:440-786-9092
Mailing Address - Fax:
Practice Address - Street 1:10701 EAST BLVD.
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44146
Practice Address - Country:US
Practice Address - Phone:216-791-3800
Practice Address - Fax:216-421-3220
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN66161041C0700X
OHS.00254781041C0700X
OHI09000741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical