Provider Demographics
NPI:1114776663
Name:LEZCANO CANGA, MALENA (RBT)
Entity type:Individual
Prefix:MS
First Name:MALENA
Middle Name:
Last Name:LEZCANO CANGA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 N KROME AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-6047
Mailing Address - Country:US
Mailing Address - Phone:754-308-9174
Mailing Address - Fax:
Practice Address - Street 1:381 N KROME AVE STE 206
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-6047
Practice Address - Country:US
Practice Address - Phone:754-308-9174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-322309106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician