Healthcare Provider Details

I. General information

NPI: 1104988005
Provider Name (Legal Business Name): LOURDES LAVANDERA HERRERA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99959 99 SW 72 ST #213
MIAMI FL
33173
US

IV. Provider business mailing address

99959 99 SW 72 ST #213
MIAMI FL
33173
US

V. Phone/Fax

Practice location:
  • Phone: 305-275-0045
  • Fax: 305-275-9912
Mailing address:
  • Phone: 305-275-0045
  • Fax: 305-275-9912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMI24
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS251
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: