Individual
WIDMARCK LUBERISSE SR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BHCM
Contact information
Practice address
929 WILSON RIDGE DR APT 1920, ORLANDO, FL 32818-6550
(305) 502-8336
Mailing address
929 WILSON RIDGE DR APT 1920, ORLANDO, FL 32818-6550
(305) 502-8336
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
101674
FL
251S00000X
Community/Behavioral Health Agency
Primary
101674
FL
Other
Enumeration date
05/20/2021
Last updated
05/20/2021
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