Healthcare Provider Details

I. General information

NPI: 1215426598
Provider Name (Legal Business Name): CHERYL C LIBURD BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

898 FAIRHAVEN ST NE
PALM BAY FL
32907-3270
US

IV. Provider business mailing address

1150 MALABAR RD SE STE 111
PALM BAY FL
32907-3239
US

V. Phone/Fax

Practice location:
  • Phone: 321-587-1912
  • Fax:
Mailing address:
  • Phone: 321-587-1912
  • Fax: 321-241-1171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: