Provider Demographics
NPI:1861087751
Name:B DE LEON BEHAVIOR MENTAL HELTH SERVICES
Entity type:Organization
Organization Name:B DE LEON BEHAVIOR MENTAL HELTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MS BCBA
Authorized Official - Prefix:MS
Authorized Official - First Name:BEATRIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:786-704-7364
Mailing Address - Street 1:6841 SW 147TH AVE APT 2H
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1006
Mailing Address - Country:US
Mailing Address - Phone:786-740-1229
Mailing Address - Fax:786-332-4848
Practice Address - Street 1:6841 SW 147TH AVE APT 2H
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-1006
Practice Address - Country:US
Practice Address - Phone:786-704-7364
Practice Address - Fax:786-332-4848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1588016216Medicaid