Healthcare Provider Details

I. General information

NPI: 1295603132
Provider Name (Legal Business Name): MARCELO LIUVAR ALFONSO LABRADA CBHCMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4531 DELEON ST STE 207
FORT MYERS FL
33907-1280
US

IV. Provider business mailing address

510 WILMINGTON PKWY
CAPE CORAL FL
33993
US

V. Phone/Fax

Practice location:
  • Phone: 239-295-0796
  • Fax: 239-236-2018
Mailing address:
  • Phone: 813-648-8019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberCBHCMS0102846
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCBHCMS0102846
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: