Individual
MIRANDA AMARIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MIRANDA
Contact information
Practice address
2336 LEXINGTON AVE N, SAINT PAUL, MN 55113-4343
(651) 765-4306
Mailing address
1024 TRANSIT AVE, SAINT PAUL, MN 55113-3327
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP4391
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
143485
UCARE
MN
05
—
164838100
—
MN
01
—
20281-10
BHP
MN
01
—
463R4AM
BLUE CROSS BLUE SHIELD
MN
Enumeration date
10/23/2006
Last updated
11/04/2020
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