Healthcare Provider Details

I. General information

NPI: 1053065052
Provider Name (Legal Business Name): LESLIE WEINGARTEN MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 LEE RD
ORLANDO FL
32810-5621
US

IV. Provider business mailing address

1338 PRIORY CIR
WINTER GARDEN FL
34787-5571
US

V. Phone/Fax

Practice location:
  • Phone: 321-972-9894
  • Fax:
Mailing address:
  • Phone: 727-452-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number11612
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: