Healthcare Provider Details

I. General information

NPI: 1588200158
Provider Name (Legal Business Name): MERCEDES MARIA LAGO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10911 W OKEECHOBEE RD UNIT 101
HIALEAH GARDENS FL
33018-8106
US

IV. Provider business mailing address

2400 SW 137TH AVE
MIAMI FL
33175-6311
US

V. Phone/Fax

Practice location:
  • Phone: 786-770-0141
  • Fax:
Mailing address:
  • Phone: 305-456-0572
  • Fax: 786-980-5700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH17213
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: