Provider Demographics
NPI:1770371221
Name:LASSO, CAMILA
Entity type:Individual
Prefix:
First Name:CAMILA
Middle Name:
Last Name:LASSO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3122 SWEET ACRES PL
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34772-9024
Mailing Address - Country:US
Mailing Address - Phone:407-837-1879
Mailing Address - Fax:
Practice Address - Street 1:17410 SR 50 STE 130
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-8188
Practice Address - Country:US
Practice Address - Phone:689-500-7176
Practice Address - Fax:877-634-9234
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4337106H00000X
FL27166101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist