Healthcare Provider Details

I. General information

NPI: 1053743013
Provider Name (Legal Business Name): LESLIE REED BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2013
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 W HIBISCUS BLVD
MELBOURNE FL
32901-2622
US

IV. Provider business mailing address

1855 W HIBISCUS BLVD
MELBOURNE FL
32901-2622
US

V. Phone/Fax

Practice location:
  • Phone: 321-345-4232
  • Fax: 321-765-6434
Mailing address:
  • Phone: 321-345-4232
  • Fax: 321-765-6434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0-13-5524
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: