MEDICARE: MRS. LOURDES BERLANGA LMFT

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	101YP2500X	Professional Counselor	MT4299	FL
2	171M00000X	Case Manager/Care Coordinator	CBHCM101389	FL
3	106H00000X	Marriage & Family Therapist	MT4299	FL

General Provider Information

NPI Number	:	1922644079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LOURDES BERLANGA LMFT

Provider Business Mailing Address
First Line	:	100 COURT ST SE STE 105
Second Line	:
City	:	LIVE OAK
State	:	FL
Zip	:	32064-3203
Country	:	US
Telephone Number	:	386-209-8734
Fax Number	:

Provider Business Practice Location Address
First Line	:	11985 COUNTY ROAD 252
Second Line	:
City	:	MC ALPIN
State	:	FL
Zip	:	32062-3206
Country	:	US
Telephone Number	:	786-398-2112
Fax Number	:

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

Provider Enumeration Date	:	11/25/2019
Last Update Date	:	12/11/2023

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