Individual provider Active NPI

Miranda Serra, LCSW

  • Clinical Social Worker
  • San Antonio, TX
National Provider Identifier
1043636830
Registry record updated Sep 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
113530 Issued in TX
Practice address
7400 Merton Minter St
San Antonio, TX 78229-4404
Phone
(210) 617-5300
NPI assigned
Mar 17, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 26, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 113530 TX Primary
Social Worker 104100000X 58630 TX

Addresses

Primary practice location

7400 Merton Minter St
San Antonio, TX 78229-4404

Mailing address

9500 Tioga Dr, Suite a
San Antonio, TX 78230-3118
Phone (210) 616-0828

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180510002349 TX Practitioner - Clinical Social Worker 9335403799 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
58630TXMDSocial Worker

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1395014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727308800000",
    "number": "1043636830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9500 TIOGA DR, SUITE A",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782303118",
            "telephone_number": "210-616-0828",
            "fax_number": "855-616-0829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7400 MERTON MINTER ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782294404",
            "telephone_number": "210-617-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SERRA",
        "first_name": "MIRANDA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-03-17",
        "last_updated": "2024-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "113530",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "TX",
            "license": "58630",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.