Provider Demographics
NPI:1295603132
Name:ALFONSO LABRADA, MARCELO LIUVAR (CBHCMS)
Entity type:Individual
Prefix:
First Name:MARCELO
Middle Name:LIUVAR
Last Name:ALFONSO LABRADA
Suffix:
Gender:M
Credentials:CBHCMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 STOCKTON ST APT 209
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-1606
Mailing Address - Country:US
Mailing Address - Phone:813-648-8019
Mailing Address - Fax:
Practice Address - Street 1:4531 DELEON ST STE 207
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1280
Practice Address - Country:US
Practice Address - Phone:239-295-0796
Practice Address - Fax:239-236-2018
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-23
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCMS0102846171M00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No171M00000XOther Service ProvidersCase Manager/Care Coordinator