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General NPI Number Information
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NPI Number | 1831652684
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Entity Type | Individual
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Provider Name | LEIDYS MARTIN
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Gender | Female
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Dates
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Enumeration Date | 04/09/2019
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 14730 SW 157TH ST
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City | MIAMI
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State | FL
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Zip | 33187-5577
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Country | US
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Telephone | 786-510-4612
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Fax |
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Provider Business Mailing Address
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Address Line | 14730 SW 157TH ST
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City | MIAMI
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State | FL
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Zip | 33187-5577
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Country | US
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Telephone | 786-808-8878
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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-19-83103
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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 | 1-23-66648
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License Number State | FL
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