Provider Demographics
NPI:1053003384
Name:LUCID MINDS
Entity type:Organization
Organization Name:LUCID MINDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGUERA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:305-439-6556
Mailing Address - Street 1:1110 BRICKELL AVE STE 407
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3135
Mailing Address - Country:US
Mailing Address - Phone:786-558-4526
Mailing Address - Fax:844-364-7241
Practice Address - Street 1:1110 BRICKELL AVE STE 407
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-3135
Practice Address - Country:US
Practice Address - Phone:786-558-4526
Practice Address - Fax:844-364-7241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty