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General NPI Number Information
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NPI Number | 1194648949
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Entity Type | Individual
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Provider Name | DEBORAH RIDORE
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Gender | Female
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Dates
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Enumeration Date | 07/30/2026
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Last Update Date | 07/30/2026
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Provider Practice Location Address
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Address Line | 12493 BRANTLEY COMMONS CT FL 33907
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City | FORT MYERS
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State | FL
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Zip | 33907-5693
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Country | US
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Telephone | 754-308-4058
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Fax |
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Provider Business Mailing Address
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Address Line | 3805 12TH ST SW
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City | LEHIGH ACRES
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State | FL
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Zip | 33976-2812
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Country | US
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Telephone | 754-308-4058
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Fax | 754-308-4058
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 1426991
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License Number State | FL
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