Individual
MIRANDA BREIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
3300 RIVERMONT AVE, LYNCHBURG, VA 24503-2030
(434) 200-5999
Mailing address
1204 FENWICK DR, LYNCHBURG, VA 24502-2112
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810001622
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
031179
VALUE OPTIONS PROVIDER NU
—
01
—
1019906
CIGNA BEHAVIOR PROVIDER N
—
01
—
186476
ANTHEM PROVIDER NUMBER
—
01
—
203639329001
TRICARE PROVIDER NUMBER
—
01
—
O87832
SENTARA PROVIDER NUMBER
—
Enumeration date
08/02/2005
Last updated
03/13/2008
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