Provider Demographics
NPI:1891553145
Name:LEXIDOR, RAYMONE
Entity Type:Individual
Prefix:
First Name:RAYMONE
Middle Name:
Last Name:LEXIDOR
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 1:4701 N FEDERAL HWY STE 460
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6591
Mailing Address - Country:US
Mailing Address - Phone:954-866-1430
Mailing Address - Fax:
Practice Address - Street 1:1201 NW 3RD AVE APT 107
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-5554
Practice Address - Country:US
Practice Address - Phone:195-486-6143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-329595106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician