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NPI Code Detail

MEDICARE: DEENA R LAVADO

MEDICARE: DEENA R LAVADO
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1063303220
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEENA R LAVADO
Provider Business Mailing Address
First Line : 1887 SE PORT ST LUCIE BLVD
Second Line :
City : PORT SAINT LUCIE
State : FL
Zip : 34952-5530
Country : US
Telephone Number : 772-463-0444
Fax Number :
Provider Business Practice Location Address
First Line : 1887 SE PORT ST LUCIE BLVD
Second Line :
City : PORT SAINT LUCIE
State : FL
Zip : 34952-5530
Country : US
Telephone Number : 772-463-0444
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2025
Last Update Date : 12/09/2025

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Directions to “ DEENA R LAVADO ” Practice Location

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