Provider Demographics
NPI:1730601048
Name:DE AGUAYO, ANDREA BEATRIZ (LMHC, PSYD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:BEATRIZ
Last Name:DE AGUAYO
Suffix:
Gender:F
Credentials:LMHC, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 PONCE DE LEON BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6044
Mailing Address - Country:US
Mailing Address - Phone:305-926-2617
Mailing Address - Fax:786-876-8369
Practice Address - Street 1:1533 SUNSET DR STE 225
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33143-5700
Practice Address - Country:US
Practice Address - Phone:305-707-1604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14214101YM0800X
FLPY10780103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH14214OtherDEPT OF HEALTH
FL101455400Medicaid
FLPY10780OtherDEPT OF HEALTH