Provider Demographics
NPI:1003685751
Name:FEO LABRADA, ADDIEL
Entity Type:Individual
Prefix:
First Name:ADDIEL
Middle Name:
Last Name:FEO LABRADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 SW 110TH TER
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4121
Mailing Address - Country:US
Mailing Address - Phone:786-519-8374
Mailing Address - Fax:
Practice Address - Street 1:1003 SE 1ST AVE
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-7104
Practice Address - Country:US
Practice Address - Phone:305-318-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician