Provider Demographics
NPI:1104712611
Name:LEBRON, ANTONIO MIGUEL
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:MIGUEL
Last Name:LEBRON
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 1:1121 GIOVANNI ST
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-5820
Mailing Address - Country:US
Mailing Address - Phone:386-383-1167
Mailing Address - Fax:
Practice Address - Street 1:502 N SPRING GARDEN AVE STE 8
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3193
Practice Address - Country:US
Practice Address - Phone:407-625-5836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-425878106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician