Provider Demographics
NPI:1487159406
Name:MIRAGLIA, SARA LAURA
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:LAURA
Last Name:MIRAGLIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 2ND ST
Mailing Address - Street 2:
Mailing Address - City:EYNON
Mailing Address - State:PA
Mailing Address - Zip Code:18403-1409
Mailing Address - Country:US
Mailing Address - Phone:570-687-6291
Mailing Address - Fax:
Practice Address - Street 1:201 LACKAWANNA AVE # 316
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1953
Practice Address - Country:US
Practice Address - Phone:570-766-0772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
PAPC016245101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No174H00000XOther Service ProvidersHealth Educator