Provider Demographics
NPI:1699015222
Name:LAZO, DUNIA (LMHC, BCBA)
Entity Type:Individual
Prefix:
First Name:DUNIA
Middle Name:
Last Name:LAZO
Suffix:
Gender:F
Credentials:LMHC, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17988 SW 97TH AVE
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5641
Mailing Address - Country:US
Mailing Address - Phone:786-827-9592
Mailing Address - Fax:786-349-1330
Practice Address - Street 1:17988 SW 97TH AVE
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5641
Practice Address - Country:US
Practice Address - Phone:305-753-2251
Practice Address - Fax:786-349-1330
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-19
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14615101YM0800X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019445100Medicaid