Healthcare Provider Details

I. General information

NPI: 1790483295
Provider Name (Legal Business Name): MIKAELA LEONZIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 PENNSYLVANIA AVE
IRWIN PA
15642-3737
US

IV. Provider business mailing address

1015 PENNSYLVANIA AVE
IRWIN PA
15642-3737
US

V. Phone/Fax

Practice location:
  • Phone: 866-287-2036
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH008307
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: