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General NPI Number Information
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NPI Number | 1912537754
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Entity Type | Individual
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Provider Name | LEIDY ESTHER MARINO
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Gender | Female
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Dates
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Enumeration Date | 01/21/2020
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Last Update Date | 01/21/2020
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Provider Practice Location Address
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Address Line | 2615 FAIRWAYS DR
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City | HOMESTEAD
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State | FL
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Zip | 33035-1173
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Country | US
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Telephone | 786-426-3686
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Fax | 305-508-6697
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Provider Business Mailing Address
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Address Line | 22416 SW 89TH PATH
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City | CUTLER BAY
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State | FL
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Zip | 33190-1336
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Country | US
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Telephone | 786-278-0749
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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 | 19-101895
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License Number State | FL
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