Provider Demographics
NPI:1891167987
Name:FRAGUELA-LAM, MAYREN (LCSW)
Entity type:Individual
Prefix:MS
First Name:MAYREN
Middle Name:
Last Name:FRAGUELA-LAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 NW 129TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-2354
Mailing Address - Country:US
Mailing Address - Phone:786-344-5626
Mailing Address - Fax:786-453-1583
Practice Address - Street 1:10691 N KENDALL DR STE 312
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1551
Practice Address - Country:US
Practice Address - Phone:786-592-8470
Practice Address - Fax:786-453-1583
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2025-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW132311041C0700X, 101YM0800X, 103K00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021357400Medicaid
FL016518400Medicaid