Provider Demographics
NPI:1982478053
Name:LAGUNA LUGO, NILDA M (MH23891)
Entity type:Individual
Prefix:
First Name:NILDA
Middle Name:M
Last Name:LAGUNA LUGO
Suffix:
Gender:F
Credentials:MH23891
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 CITRUS TOWER BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6880
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3115 CITRUS TOWER BLVD STE D
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6880
Practice Address - Country:US
Practice Address - Phone:786-926-1424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH23891101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH23891OtherLICENSED MENTAL HEALTH COUNSELOR