Basic Information
| Provider Information | |||||||||
| NPI: | 1700352119 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUGO | ||||||||
| FirstName: | JULIO | ||||||||
| MiddleName: | CESAR | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | SR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1639 FORUM PLACE, SUITE #107, WPB, FL, 33401 | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7724752635 | ||||||||
| FaxNumber: | 5617128070 | ||||||||
| Practice Location | |||||||||
| Address1: | 4100 BEAR LAKES CT. BUILDING 14, APT. #108, | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7724752635 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2018 | ||||||||
| LastUpdateDate: | 10/23/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.