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General NPI Number Information
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NPI Number | 1679719876
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Entity Type | Individual
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Provider Name | MS. WENDY LEIBA
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Gender | Female
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Dates
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Enumeration Date | 12/18/2008
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Last Update Date | 07/01/2015
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Provider Practice Location Address
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Address Line | 1800 PEMBROOK DRIVE SUITE 300
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City | ORLANDO
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State | FL
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Zip | 32810-1512
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Country | US
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Telephone | 407-406-2577
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Fax |
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Provider Business Mailing Address
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Address Line | 2139 JUDITH PL
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City | LONGWOOD
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State | FL
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Zip | 32779-7012
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Country | US
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Telephone | 407-406-2577
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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