MEDICARE: MAVIE NEW LEAF CARE GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1619830569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAVIE NEW LEAF CARE GROUP LLC

Provider Business Mailing Address
First Line	:	12114 MAGAZINE ST APT 3210
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-5536
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12114 MAGAZINE ST APT 3210
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-5536
Country	:	US
Telephone Number	:	772-607-4603
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. LEEWENSKY ALEXANDER
Credential	:
Telephone Number	:	772-607-4693

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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Directions to “MAVIE NEW LEAF CARE GROUP LLC ” Practice Location

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