Provider Demographics
NPI:1144062548
Name:ZACKOWSKI, LETICIA REYES (RBT)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:REYES
Last Name:ZACKOWSKI
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 1:39442 COUNTY ROAD 54 # 37
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-2821
Mailing Address - Country:US
Mailing Address - Phone:850-741-6230
Mailing Address - Fax:
Practice Address - Street 1:3997 ETERNITY CIR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34772-8268
Practice Address - Country:US
Practice Address - Phone:321-202-6913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNBACB1101170106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician