Miranda Lyn Middona, LCSW
Individual provider Active NPI Clinical Social Worker · Elburn, IL
NPI 1619232154 · NPPES record last updated Jul 11, 2012
Key facts
- NPI
- 1619232154
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 149015352 (IL)
- Practice address
- 913 Kindberg Court
Elburn, IL 60119 - Phone
- (630) 365-4211
- NPI assigned
- Jul 11, 2012
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149015352 | IL | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 149015352 | IL | |
| Social Worker | 104100000X | 149015352 | IL | |
| Clinical Social Worker | 1041C0700X | 149015352 | IL | Yes |
Addresses
Primary practice location
913 Kindberg Court
Elburn, IL 60119
Mailing address
913 Kindberg Court
Elburn, IL 60119
Phone (630) 365-4211
Other providers in Elburn, IL
- Kayla E Lehman
- Michael William Mangis
- Laura S Medlin
- Erika Kristin Mennerick
- Michael Schuiling DDS PLLC
- Marion Jean Miller
- Mind Matters PLLC
- Modus Operandi LLC
- Danielle Nowak
- Ocken Speech Therapy LLC
All providers in Elburn, IL · Clinical Social Worker in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 11, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.