Provider Demographics
NPI:1598105736
Name:LAVADO, MEGAN MICHELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:MICHELLE
Last Name:LAVADO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17501 BISCAYNE BLVD STE 450
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4806
Mailing Address - Country:US
Mailing Address - Phone:305-510-1025
Mailing Address - Fax:
Practice Address - Street 1:17501 BISCAYNE BLVD STE 450
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-4806
Practice Address - Country:US
Practice Address - Phone:305-933-5733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9725103T00000X
FLPY 9725103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY 9725OtherLICENSED PSYCHOLOGIST