Provider Demographics
NPI:1407384159
Name:LEBREDO, INGRID M (BCBA)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:M
Last Name:LEBREDO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18064 SW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5209
Mailing Address - Country:US
Mailing Address - Phone:786-399-8439
Mailing Address - Fax:561-619-7423
Practice Address - Street 1:11820 MIRAMAR PKWY STE 214
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-5818
Practice Address - Country:US
Practice Address - Phone:786-399-8439
Practice Address - Fax:561-619-7423
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102963300Medicaid