Provider Demographics
NPI:1952839664
Name:LUGO MOREJON, MAIRELYS
Entity Type:Individual
Prefix:
First Name:MAIRELYS
Middle Name:
Last Name:LUGO MOREJON
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 1:2418 SW 42ND TERRA
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33317-6622
Mailing Address - Country:US
Mailing Address - Phone:954-394-8273
Mailing Address - Fax:
Practice Address - Street 1:2418 SW 42ND TERRA
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33317-6622
Practice Address - Country:US
Practice Address - Phone:954-394-8273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-24
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst