MEDICARE: LEBREDO BEHAVIOR ANALYSIS SERVICES CORP.

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

General Provider Information

NPI Number	:	1720605017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEBREDO BEHAVIOR ANALYSIS SERVICES CORP.

Provider Business Mailing Address
First Line	:	18064 SW 20TH ST
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33029-5209
Country	:	US
Telephone Number	:	786-399-8439
Fax Number	:	561-619-7423

Provider Business Practice Location Address
First Line	:	11820 MIRAMAR PKWY STE 214
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-5818
Country	:	US
Telephone Number	:	786-399-8439
Fax Number	:	561-619-7423

Authorized Official
Title or Position	:	PRESIDENT
Name	:	INGRID M LEBREDO
Credential	:	BCBA
Telephone Number	:	786-399-8439

Provider Enumeration Date	:	07/02/2020
Last Update Date	:	05/22/2023

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