Provider Demographics
NPI:1265788715
Name:KOFELDT, MIRANDA M GARAY (PHD)
Entity type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:M GARAY
Last Name:KOFELDT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:MICHELE
Other - Last Name:GARAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 W PRATT ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1023
Mailing Address - Country:US
Mailing Address - Phone:410-328-6018
Mailing Address - Fax:410-328-6391
Practice Address - Street 1:701 W PRATT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1023
Practice Address - Country:US
Practice Address - Phone:410-328-6018
Practice Address - Fax:410-328-6391
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health