Provider Demographics
NPI:1558093351
Name:WASHINGTON, LEBRUN BEATRIX
Entity Type:Individual
Prefix:
First Name:LEBRUN
Middle Name:BEATRIX
Last Name:WASHINGTON
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 1:400 W BEACON RD APT 108
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-7234
Mailing Address - Country:US
Mailing Address - Phone:813-235-5993
Mailing Address - Fax:
Practice Address - Street 1:400 W BEACON RD APT 108
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-7234
Practice Address - Country:US
Practice Address - Phone:813-235-5993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist