Provider Demographics
NPI:1407323728
Name:DE LUGO, ANTONIA ENCARNACION (MFT)
Entity Type:Individual
Prefix:
First Name:ANTONIA
Middle Name:ENCARNACION
Last Name:DE LUGO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:ANTONIA
Other - Middle Name:
Other - Last Name:ENCANACION CASTRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:1639 FORUM PLACE
Mailing Address - Street 2:SUITE # 7
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2330
Mailing Address - Country:US
Mailing Address - Phone:561-712-8821
Mailing Address - Fax:561-712-8070
Practice Address - Street 1:1639 FORUM PLACE
Practice Address - Street 2:SUITE # 7
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2330
Practice Address - Country:US
Practice Address - Phone:561-712-8821
Practice Address - Fax:561-712-8070
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health