Provider Demographics
NPI:1710530811
Name:LAM, LETICIA
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:LAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8703 SW 161ST CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5407
Mailing Address - Country:US
Mailing Address - Phone:786-227-0906
Mailing Address - Fax:
Practice Address - Street 1:17400 SW 267TH LN
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33031-2336
Practice Address - Country:US
Practice Address - Phone:305-910-5057
Practice Address - Fax:786-481-5350
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician