Individual
MRS. MIRANDA MUSSARIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1717 TAYLOR AVE, RACINE, WI 53403-2405
(262) 638-6865
Mailing address
1717 TAYLOR AVE, RACINE, WI 53403-2405
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
363542328
—
IL
Enumeration date
10/13/2017
Last updated
09/20/2022
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