Provider Demographics
NPI:1518748243
Name:THELEMAQUE, LURIO
Entity Type:Individual
Prefix:
First Name:LURIO
Middle Name:
Last Name:THELEMAQUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2429 LENA LN
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-7277
Mailing Address - Country:US
Mailing Address - Phone:561-827-0161
Mailing Address - Fax:
Practice Address - Street 1:4111 20TH ST SW FL 33976
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33976-3210
Practice Address - Country:US
Practice Address - Phone:239-766-2125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst