Provider Demographics
NPI:1063030831
Name:FLEURMONT, HIDES SR (BEHAVIOR TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:HIDES
Middle Name:
Last Name:FLEURMONT
Suffix:SR
Gender:M
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5654 BARNSTEAD CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-6683
Mailing Address - Country:US
Mailing Address - Phone:321-295-6165
Mailing Address - Fax:
Practice Address - Street 1:5654 BARNSTEAD CIR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-6683
Practice Address - Country:US
Practice Address - Phone:321-295-6165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician