Provider Demographics
NPI:1922644079
Name:BERLANGA, LOURDES (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:
Last Name:BERLANGA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 COURT ST SE STE 105
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-3203
Mailing Address - Country:US
Mailing Address - Phone:386-209-8734
Mailing Address - Fax:
Practice Address - Street 1:11985 COUNTY ROAD 252
Practice Address - Street 2:
Practice Address - City:MC ALPIN
Practice Address - State:FL
Practice Address - Zip Code:32062-3206
Practice Address - Country:US
Practice Address - Phone:786-398-2112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4299101YP2500X, 106H00000X
FLCBHCM101389171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator