Provider Demographics
NPI:1154120202
Name:MWAGALA, FLORA LUCAS
Entity type:Individual
Prefix:
First Name:FLORA
Middle Name:LUCAS
Last Name:MWAGALA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 5TH AVE RM 1108
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6655
Mailing Address - Country:US
Mailing Address - Phone:212-960-8626
Mailing Address - Fax:646-774-0376
Practice Address - Street 1:701 RAWS AVE
Practice Address - Street 2:
Practice Address - City:SOMERDALE
Practice Address - State:NJ
Practice Address - Zip Code:08083-1237
Practice Address - Country:US
Practice Address - Phone:856-291-0822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health