Healthcare Provider Details

I. General information

NPI: 1770371221
Provider Name (Legal Business Name): CAMILA LASSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17410 SR 50 STE 130
CLERMONT FL
34711-8188
US

IV. Provider business mailing address

3122 SWEET ACRES PL
SAINT CLOUD FL
34772-9024
US

V. Phone/Fax

Practice location:
  • Phone: 689-500-7176
  • Fax: 877-634-9234
Mailing address:
  • Phone: 407-837-1879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number27166
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4337
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: