MEDICARE: DR. ANDREA BEATRIZ DE AGUAYO LMHC, PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH14214	FL
2	103T00000X	Psychologist	PY10780	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MH14214	OTHER	FL	DEPT OF HEALTH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	PY10780	OTHER	FL	DEPT OF HEALTH
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730601048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREA BEATRIZ DE AGUAYO LMHC, PSYD

Provider Business Mailing Address
First Line	:	2525 PONCE DE LEON BLVD STE 300
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-6044
Country	:	US
Telephone Number	:	305-926-2617
Fax Number	:	786-876-8369

Provider Business Practice Location Address
First Line	:	1533 SUNSET DR STE 225
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33143-5700
Country	:	US
Telephone Number	:	305-707-1604
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2017
Last Update Date	:	04/24/2023

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