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NPI Code Detail

MEDICARE: MARIAM LEYVA CORELLA

MEDICARE: MARIAM LEYVA CORELLA
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
1106E00000XAssistant Behavior AnalystBCABA0-25-16760FL
2106S00000XBehavior Technician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1649979139
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIAM LEYVA CORELLA
Provider Business Mailing Address
First Line : 11857 67TH PL N
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33412-2061
Country : US
Telephone Number : 561-574-3852
Fax Number :
Provider Business Practice Location Address
First Line : 4793 N CONGRESS AVE STE 203
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33426-7937
Country : US
Telephone Number : 561-772-9107
Fax Number : 561-448-6063
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2023
Last Update Date : 04/15/2026

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Directions to “ MARIAM LEYVA CORELLA ” Practice Location

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