Provider Demographics
NPI:1508602012
Name:GAYOSO, MICHELLE LAUREN
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LAUREN
Last Name:GAYOSO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:LAUREN
Other - Last Name:CUERVO ECHENIQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, NCC
Mailing Address - Street 1:7220 SW 130TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3454
Mailing Address - Country:US
Mailing Address - Phone:786-352-1776
Mailing Address - Fax:
Practice Address - Street 1:7220 SW 130TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-3454
Practice Address - Country:US
Practice Address - Phone:786-352-1776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26115101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health