Provider Demographics
NPI:1710588595
Name:NADEAU, MIRANDA MEI (PHD)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:MEI
Last Name:NADEAU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 HEADWAY CIR STE 9538
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5123
Mailing Address - Country:US
Mailing Address - Phone:512-354-4615
Mailing Address - Fax:
Practice Address - Street 1:4617 BROADWAY
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-6504
Practice Address - Country:US
Practice Address - Phone:512-354-4615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38521103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX38521OtherTEXAS BEHAVIORAL HEALTH EXECUTIVE COUNCIL