=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982168456
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LESLIE CABRAL BCBA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2019
-----------------------------------------------------
Last Update Date | 01/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 504 E BAKER ST STE 1
-----------------------------------------------------
City | PLANT CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33563-3558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-704-6297
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1500 SUNSET RD APT F1
-----------------------------------------------------
City | TARPON SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34689-2747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-685-6579
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 12365970
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------