Provider Demographics
NPI:1043612146
Name:ELGUETA, MIGUEL A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:A
Last Name:ELGUETA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:MIGUEL
Other - Middle Name:A
Other - Last Name:ELGUETA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:9033 NW 146TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33018-7310
Mailing Address - Country:US
Mailing Address - Phone:305-200-9624
Mailing Address - Fax:
Practice Address - Street 1:9033 NW 146TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33018-7310
Practice Address - Country:US
Practice Address - Phone:305-200-9624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW120581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical