Provider Demographics
NPI:1417522756
Name:LEGON, BARBARA LIDIERKYS
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:LIDIERKYS
Last Name:LEGON
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 1:200 NW 114TH AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4747
Mailing Address - Country:US
Mailing Address - Phone:786-443-4167
Mailing Address - Fax:
Practice Address - Street 1:200 NW 114TH AVE APT 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4747
Practice Address - Country:US
Practice Address - Phone:786-443-4167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician