MEDICARE: MEAGAN LIDE BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053884387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEAGAN LIDE BCBA

Provider Business Mailing Address
First Line	:	6901 OKEECHOBEE BLVD STE D5
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-2517
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2647 SW 137TH AVE
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-3927
Country	:	US
Telephone Number	:	954-892-4240
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2019
Last Update Date	:	03/31/2023

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Directions to “ MEAGAN LIDE BCBA” Practice Location

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