Provider Demographics
NPI:1063026334
Name:MELGARES, LIENA ROQUE
Entity type:Individual
Prefix:
First Name:LIENA
Middle Name:ROQUE
Last Name:MELGARES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 SOCIETY PL W APT G
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-3784
Mailing Address - Country:US
Mailing Address - Phone:786-205-6954
Mailing Address - Fax:
Practice Address - Street 1:5130 SOCIETY PL W APT G
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-3784
Practice Address - Country:US
Practice Address - Phone:786-205-6954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL1-2579273103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician