Provider Demographics
NPI:1649083817
Name:LEBRON, RAYMOND (CBHCM)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:LEBRON
Suffix:
Gender:M
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 BANYON TREE CIR APT 100
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5953
Mailing Address - Country:US
Mailing Address - Phone:305-992-3293
Mailing Address - Fax:
Practice Address - Street 1:404 BANYON TREE CIR APT 100
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5953
Practice Address - Country:US
Practice Address - Phone:305-992-3293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM.0107264171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator