Provider Demographics
NPI:1861176174
Name:LEVY, ALAILA G
Entity type:Individual
Prefix:
First Name:ALAILA
Middle Name:G
Last Name:LEVY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6208 KAIETEUR LN # IN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-1472
Mailing Address - Country:US
Mailing Address - Phone:321-261-4588
Mailing Address - Fax:
Practice Address - Street 1:6208 KAIETEUR LN # IN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-1472
Practice Address - Country:US
Practice Address - Phone:321-261-4588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-278083106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician