MEDICARE: MARIAM LEYVA CORELLA

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	106E00000X	Assistant Behavior Analyst	BCABA0-25-16760	FL
2	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649979139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAM LEYVA CORELLA

Provider Business Mailing Address
First Line	:	11857 67TH PL N
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33412-2061
Country	:	US
Telephone Number	:	561-574-3852
Fax Number	:

Provider Business Practice Location Address
First Line	:	4793 N CONGRESS AVE STE 203
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-7937
Country	:	US
Telephone Number	:	561-772-9107
Fax Number	:	561-448-6063

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2023
Last Update Date	:	02/11/2026

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