Provider Demographics
NPI:1669191862
Name:LUGO, LESLIE ANN
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:ANN
Last Name:LUGO
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 1:13344 MEADOW BAY LOOP
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-5078
Mailing Address - Country:US
Mailing Address - Phone:321-400-7088
Mailing Address - Fax:
Practice Address - Street 1:13344 MEADOW BAY LOOP
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-5078
Practice Address - Country:US
Practice Address - Phone:321-400-7088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-227965106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician