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General NPI Number Information
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NPI Number | 1730695933
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Entity Type | Individual
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Provider Name | LEONARDO LORENZO CHACON ASUSTA
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Gender | Male
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Dates
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Enumeration Date | 12/26/2017
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Last Update Date | 08/14/2019
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Provider Practice Location Address
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Address Line | 4490 SW 5 TERR
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City | CORAL GABLES
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State | FL
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Zip | 33134
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Country | US
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Telephone | 305-298-4089
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Fax |
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Provider Business Mailing Address
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Address Line | 4490 SW 5TH TER
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City | CORAL GABLES
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State | FL
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Zip | 33134-1961
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Country | US
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Telephone | 305-298-4089
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW15007
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | SW15007
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License Number State | FL
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