Individual
JOHNNY MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
B.A
Contact information
Practice address
2155 MAIN ST, SPRINGFIELD, MA 01104-3301
(413) 736-0395
(413) 734-1651
Mailing address
147 NORMAN ST, WEST SPRINGFIELD, MA 01089-5003
(413) 736-8329
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042622756
COMMONWEALTH CARE ALLIANCE
MA
01
—
1022610
NHP
MA
01
—
12529
HEALTH NEW ENGLAND
MA
01
—
1307576
MBHP
MA
05
—
1307576
—
MA
01
—
71756
TUFTS
MA
01
—
8443
BMC
MA
01
—
997203
NETWORK HEALTH
MA
01
—
Y10086
MEDICARE
MA
Enumeration date
11/06/2013
Last updated
11/06/2013
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