Provider Demographics
NPI:1144955832
Name:MIRANDA OROZCO, LESLY
Entity type:Individual
Prefix:
First Name:LESLY
Middle Name:
Last Name:MIRANDA OROZCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LESLY
Other - Middle Name:
Other - Last Name:MIRANDA OROZCO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RBT
Mailing Address - Street 1:3812 S LAKE TER
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-4948
Mailing Address - Country:US
Mailing Address - Phone:786-663-4534
Mailing Address - Fax:
Practice Address - Street 1:S.ALKE3812 S LAKE TER
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023
Practice Address - Country:US
Practice Address - Phone:786-663-4534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22202596103K00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty