Healthcare Provider Details

I. General information

NPI: 1215295795
Provider Name (Legal Business Name): MIREYA Y LEON BA IN PSYCHOLOGY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 SW 104TH AVE
MIAMI FL
33174-2752
US

IV. Provider business mailing address

1122 SW 104TH AVE
MIAMI FL
33174-2752
US

V. Phone/Fax

Practice location:
  • Phone: 786-715-2115
  • Fax:
Mailing address:
  • Phone: 786-715-2115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-21-12964
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: