Healthcare Provider Details

I. General information

NPI: 1073298840
Provider Name (Legal Business Name): LETICIA BENEDIKT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9070 KIMBERLY BLVD STE 19-20
BOCA RATON FL
33434-2855
US

IV. Provider business mailing address

3370 BEAU RIVAGE DR APT U2
POMPANO BEACH FL
33064-2042
US

V. Phone/Fax

Practice location:
  • Phone: 954-988-0918
  • Fax:
Mailing address:
  • Phone: 954-861-8887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-86359
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: