Miranda Elliott, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW007201 Issued in GA

Practice address

600 Coastal Village Dr
Brunswick, GA 31520-1973

Phone

(125) 548-5009

NPI assigned

Aug 12, 2020

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.

• Gateway Behavioral Health Services

  • Mental Illness Community Based Residential Treatment Facility
  • Brunswick, GA
  • NPI 1124254321
  NPD (past)
• Gateway Community Service Board

  • Community/Behavioral Health Agency
  • Brunswick, GA
  • NPI 1558478214
  NPD (past)

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

{
    "created_epoch": "1597190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597190400000",
    "number": "1568073658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 SW BROAD ST",
            "city": "JESUP",
            "state": "GA",
            "postal_code": "315451100",
            "telephone_number": "912-280-7023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 COASTAL VILLAGE DR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315201973",
            "telephone_number": "125-548-5009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "MIRANDA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-12",
        "last_updated": "2020-08-12",
        "certification_date": "2020-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW007201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew C D Eller, D.P.M.
• David Ellett
• Ellington Eyecare PLLC
• Carol F Elliott, AA-C
• Katherine Elizabeth Elliott
• Ahmed Elsharkawi, M.D.
• Emergency Physicians Inc
• Paige Emling, HAD
• Emri Comer, O.D., PC
• Brendan Clark Engen, PSY.D.

• Clinical Social Worker in Brunswick, GA
• Providers in Brunswick, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2020; 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.