Miranda A Dickess, LISW-S

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I.2002359 Issued in OH

Practice address

700 Park Ave
Ironton, OH 45638

Phone

(740) 532-1613

Fax

(740) 532-1715

NPI assigned

Oct 4, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Mended Reeds Services, Inc.

  • Community/Behavioral Health Agency
  • Ironton, OH
  • NPI 1407261977

  OH, Social Worker

  Medicare reassignment NPD

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

{
    "created_epoch": "1507075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667865600000",
    "number": "1578073573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 108",
            "city": "IRONTON",
            "state": "OH",
            "postal_code": "456380108",
            "telephone_number": "740-532-1613",
            "fax_number": "740-532-1715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 PARK AVE",
            "city": "IRONTON",
            "state": "OH",
            "postal_code": "45638",
            "telephone_number": "740-532-1613",
            "fax_number": "740-532-1715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKESS",
        "first_name": "MIRANDA",
        "middle_name": "A",
        "credential": "LISW-S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-04",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S.1701362",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.2002359",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0290702",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephanie Renee Diamond, LPN
• Kaydance Dickerson
• Casey Dickess
• Danny Dickess
• Hallie N Dickess, CDCA
• Morgan Dilley, CDCA
• Peggy Fontaine Dilley
• Amy Dillon
• Georgia Dillon, RNC,WHNP
• Julie Disney, LSW

• All providers in Ironton, OH
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.