Provider Demographics
NPI:1629493721
Name:SARAVIA, GUSTAVO (LMHC)
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:
Last Name:SARAVIA
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13200 SW 128TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5881
Mailing Address - Country:US
Mailing Address - Phone:786-478-2412
Mailing Address - Fax:
Practice Address - Street 1:28870 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-2405
Practice Address - Country:US
Practice Address - Phone:305-247-4009
Practice Address - Fax:305-247-4009
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12355101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health