Provider Demographics
NPI:1740094226
Name:LAGE, KAMILA ALEJANDRA
Entity type:Individual
Prefix:
First Name:KAMILA
Middle Name:ALEJANDRA
Last Name:LAGE
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 1:3079 NW 11TH ST
Mailing Address - Street 2:3071
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-5361
Mailing Address - Country:US
Mailing Address - Phone:813-850-4013
Mailing Address - Fax:
Practice Address - Street 1:3079 NW 11TH ST
Practice Address - Street 2:3071
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-5361
Practice Address - Country:US
Practice Address - Phone:813-850-4013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-404570106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician