Provider Demographics
NPI:1568271195
Name:VALDES LEBROC, MABIA
Entity type:Individual
Prefix:
First Name:MABIA
Middle Name:
Last Name:VALDES LEBROC
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 1:3110 5TH ST W
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-1441
Mailing Address - Country:US
Mailing Address - Phone:239-237-6405
Mailing Address - Fax:
Practice Address - Street 1:3351 MARINATOWN LN STE 200
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-7000
Practice Address - Country:US
Practice Address - Phone:239-895-5014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
FLRBT24399023106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician