MEDICARE: MARYSEL LEON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1477060978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYSEL LEON

Provider Business Mailing Address
First Line	:	3750 NE 170TH ST APT 211
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33160-3101
Country	:	US
Telephone Number	:	305-240-7135
Fax Number	:

Provider Business Practice Location Address
First Line	:	3750 NE 170TH ST APT 211
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33160-3101
Country	:	US
Telephone Number	:	305-240-7135
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2018
Last Update Date	:	01/05/2018

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Directions to “ MARYSEL LEON ” Practice Location

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