Provider Demographics
NPI:1598363806
Name:LAGO-PEDRICK, ANABEL (LMHC)
Entity Type:Individual
Prefix:
First Name:ANABEL
Middle Name:
Last Name:LAGO-PEDRICK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 172
Mailing Address - Street 2:
Mailing Address - City:MAPLECREST
Mailing Address - State:NY
Mailing Address - Zip Code:12454-0172
Mailing Address - Country:US
Mailing Address - Phone:518-527-2726
Mailing Address - Fax:
Practice Address - Street 1:539 COUNTY ROAD 40
Practice Address - Street 2:
Practice Address - City:MAPLECREST
Practice Address - State:NY
Practice Address - Zip Code:12454-1245
Practice Address - Country:US
Practice Address - Phone:518-527-2726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)