Provider Demographics
NPI:1154069474
Name:BREENAN MACEO, ALINA MARGARITA
Entity Type:Individual
Prefix:
First Name:ALINA
Middle Name:MARGARITA
Last Name:BREENAN MACEO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4290 S LANDAR DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-8915
Mailing Address - Country:US
Mailing Address - Phone:432-888-3095
Mailing Address - Fax:
Practice Address - Street 1:4290 S LANDAR DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-8915
Practice Address - Country:US
Practice Address - Phone:432-888-3095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-200811106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician