Provider Demographics
NPI:1104988005
Name:HERRERA, LOURDES LAVANDERA (PSYD)
Entity type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:LAVANDERA
Last Name:HERRERA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99959 99 SW 72 ST
Mailing Address - Street 2:#213
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173
Mailing Address - Country:US
Mailing Address - Phone:305-275-0045
Mailing Address - Fax:305-275-9912
Practice Address - Street 1:99959 99 SW 72 ST
Practice Address - Street 2:#213
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173
Practice Address - Country:US
Practice Address - Phone:305-275-0045
Practice Address - Fax:305-275-9912
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLMI24101YM0800X
FLSS251103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSS251OtherSCHOOL PSYCHOLOGIST
FLMH124OtherMENTAL HEALTH COUNSELOR 9