Provider Demographics
NPI:1821400177
Name:LEDFORD, RENE (LCSW, BCBA)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:
Last Name:LEDFORD
Suffix:
Gender:F
Credentials:LCSW, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W EAU GALLIE BLVD
Mailing Address - Street 2:SUITE 201U
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-4149
Mailing Address - Country:US
Mailing Address - Phone:321-213-7370
Mailing Address - Fax:321-241-4687
Practice Address - Street 1:1600 W EAU GALLIE BLVD
Practice Address - Street 2:SUITE 201U
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4149
Practice Address - Country:US
Practice Address - Phone:321-213-7370
Practice Address - Fax:321-241-4687
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW-50211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical