Miranda Rae Fani Srour, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

115136 Issued in MA

Practice address

1145 Sagamore Ave
Portsmouth, NH 03801-5585

Phone

(603) 431-6703

Fax

(603) 430-3753

NPI assigned

Nov 24, 2006

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

Other identifiers 2

Other names 1

• Miranda Rae Myers Former name

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.

• Seacoast Mental Health Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Portsmouth, NH
  • NPI 1013092857
  NPD (past)

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

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537401600000",
    "number": "1710052618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 MERRY MEETING LN",
            "city": "RYE",
            "state": "NH",
            "postal_code": "038702325",
            "telephone_number": "617-504-5737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1145 SAGAMORE AVE",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038015585",
            "telephone_number": "603-431-6703",
            "fax_number": "603-430-3753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANI SROUR",
        "first_name": "MIRANDA",
        "middle_name": "RAE",
        "name_prefix": "Mrs.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-24",
        "last_updated": "2018-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "115136",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BHN",
            "identifier": "7706655Y0NH01",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "99003227",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIRANDA",
            "last_name": "MYERS",
            "middle_name": "RAE",
            "credential": "MSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Julie Fallon, PT
• Paul Anthony Fallon, M.D
• Family Acupuncture & Herbs
• Daniel J Faneuf, HIS
• Laurie Faneuf, HIS
• Katherine Fanning
• Danna Seaholm Fannon, FNP
• Kristy Lee Fassler, N.D.
• Catherine Fatina, MSW
• Delfin M Faustino, D.D.S.

• Clinical Social Worker in Portsmouth, NH
• Providers in Portsmouth, NH by specialty
• Clinical Social Worker in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2018; 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.