Healthcare Provider Details

I. General information

NPI: 1639957913
Provider Name (Legal Business Name): LENS WOODNERSON LABORDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 SW 20TH PL STE 302
OCALA FL
34471-0858
US

IV. Provider business mailing address

50 WILLOW DR
ORLANDO FL
32807-3220
US

V. Phone/Fax

Practice location:
  • Phone: 877-823-4283
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-82083
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: