Provider Demographics
NPI:1437509551
Name:LEBRON, MARIELY
Entity Type:Individual
Prefix:
First Name:MARIELY
Middle Name:
Last Name:LEBRON
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 1:9655 HOLLYHILL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-9504
Mailing Address - Country:US
Mailing Address - Phone:407-729-8088
Mailing Address - Fax:
Practice Address - Street 1:9655 HOLLYHILL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-9504
Practice Address - Country:US
Practice Address - Phone:407-729-8088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator