Individual
MRS. MIRANDA RAE FANI SROUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
1145 SAGAMORE AVE, PORTSMOUTH, NH 03801-5585
(603) 431-6703
(603) 430-3753
Mailing address
4 MERRY MEETING LN, RYE, NH 03870-2325
(617) 504-5737
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
115136
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7706655Y0NH01
BHN
NH
05
—
99003227
—
NH
Enumeration date
11/24/2006
Last updated
09/20/2018
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