Active NPI
Caitlin Marie Miranda, PH.D.
- Clinical Neuropsychologist
- Riverhead, NY
National Provider Identifier
1821640079
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 023050
- Practice address
- 21 E 2ND St
Riverhead, NY 11901-4686 - Phone
- (631) 766-8702
- NPI assigned
- Jul 9, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 29705 | CA | |
| Clinical Neuropsychologist | 103G00000X | 023050 | NY | Primary |
Addresses
Primary practice location
21 E 2ND St
Riverhead, NY 11901-4686
Mailing address
5 Harrison Ter
East Quogue, NY 11942-4320
Phone (917) 747-5022
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 24, 2022 through May 24, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1562630400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562630400000",
"number": "1821640079",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 HARRISON TER",
"city": "EAST QUOGUE",
"state": "NY",
"postal_code": "119424320",
"telephone_number": "917-747-5022"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 E 2ND ST",
"city": "RIVERHEAD",
"state": "NY",
"postal_code": "119014686",
"telephone_number": "631-766-8702"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIRANDA",
"first_name": "CAITLIN",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-07-09",
"last_updated": "2019-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "29705",
"primary": false
},
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "NY",
"license": "023050",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverhead, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.