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General NPI Number Information
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NPI Number | 1053003384
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Entity Type | Organization
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Legal Business Name | LUCID MINDS
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Dates
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Enumeration Date | 05/24/2023
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Last Update Date | 05/24/2023
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Provider Practice Location Address
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Address Line | 1110 BRICKELL AVE STE 407
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City | MIAMI
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State | FL
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Zip | 33131-3135
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Country | US
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Telephone | 786-558-4526
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Fax | 844-364-7241
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Provider Business Mailing Address
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Address Line | 1110 BRICKELL AVE STE 407
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City | MIAMI
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State | FL
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Zip | 33131-3135
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Country | US
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Telephone | 786-558-4526
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Fax | 844-364-7241
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | MAYRA BURGUERA
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Credential | PSYD
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Telephone | 305-439-6556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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