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General NPI Number Information
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NPI Number | 1487390076
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Entity Type | Individual
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Provider Name | MS. LEIA GENESIS RAINE FORERO
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Gender | Female
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Dates
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Enumeration Date | 05/07/2022
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 9999 NE 2ND AVE STE 204
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City | MIAMI SHORES
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State | FL
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Zip | 33138-2345
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Country | US
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Telephone | 786-626-2552
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Fax |
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Provider Business Mailing Address
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Address Line | 17890 W DIXIE HWY APT 112
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33160-4823
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Country | US
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Telephone | 786-626-2552
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-22-203340
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 0-25-16681
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License Number State | FL
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