Basic Information
| Provider Information | |||||||||
| NPI: | 1902884687 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIRANDA-VELAZQUEZ | ||||||||
| FirstName: | ILEANA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010604127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135877500 | ||||||||
| FaxNumber: | 4135851355 | ||||||||
| Practice Location | |||||||||
| Address1: | 108 RUSSELL ST | ||||||||
| Address2: | |||||||||
| City: | HADLEY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010359595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4133870075 | ||||||||
| FaxNumber: | 4133870074 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2006 | ||||||||
| LastUpdateDate: | 02/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0809X | 236837 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Adult |
No ID Information.