Provider Demographics
NPI:1306624234
Name:BARRIOS LAGO, MARIO SERGIO (BCABA)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:SERGIO
Last Name:BARRIOS LAGO
Suffix:
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 NW 48TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5118
Mailing Address - Country:US
Mailing Address - Phone:786-520-0140
Mailing Address - Fax:
Practice Address - Street 1:210 NW 48TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5118
Practice Address - Country:US
Practice Address - Phone:786-520-0140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-25-79401103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst