Medjine M Mirambeau

Primary specialty

Social WorkerTaxonomy code 104100000X

License

MSW011866 Issued in GA

Practice address

545 N Benjamin LN
Boise, ID 83704-9623

Phone

(208) 322-1026

NPI assigned

Apr 29, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Pathways of Idaho, LLC

  • Community/Behavioral Health Agency
  • Boise, ID
  • NPI 1326466988
  NPD (past)

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

{
    "created_epoch": "1714348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714348800000",
    "number": "1245086370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2244 PELHAM PASS",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300199502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 N BENJAMIN LN",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837049623",
            "telephone_number": "208-322-1026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRAMBEAU",
        "first_name": "MEDJINE",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-29",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "GA",
            "license": "MSW011866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Minns, DO
• Alia Minoletti
• Kimberlee Barrett Minter, LCSW
• Barbara Alison Minton, PH.D.
• Miracle Home Care LLC
• Xiomara Miranda
• Sayed Hellaluddin Mirbacha
• Sayed Mazharuddin Mirbacha
• Brooke F Mischkot, MD
• Emily Misner

• Social Worker in Boise, ID
• Providers in Boise, ID by specialty
• Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.