Provider Demographics
NPI:1609059245
Name:CAGLIN, HERON DACIA (MED, EDS)
Entity Type:Individual
Prefix:MS
First Name:HERON
Middle Name:DACIA
Last Name:CAGLIN
Suffix:
Gender:F
Credentials:MED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 BROKEN OAK DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4270
Mailing Address - Country:US
Mailing Address - Phone:407-446-0480
Mailing Address - Fax:
Practice Address - Street 1:1408 BROKEN OAK DR
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4270
Practice Address - Country:US
Practice Address - Phone:407-446-0480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2137106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist