MEDICARE: DIPSY TREJO LEAL

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	101YM0800X	Mental Health Counselor		FL
2	106E00000X	Assistant Behavior Analyst	BCABA0-19-10108

Other Identifiers

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

General Provider Information

NPI Number	:	1770007353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIPSY TREJO LEAL

Provider Business Mailing Address
First Line	:	14919 SW 80TH ST APT 112
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-3151
Country	:	US
Telephone Number	:	516-849-7405
Fax Number	:

Provider Business Practice Location Address
First Line	:	2206 SW 138TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-6352
Country	:	US
Telephone Number	:	516-849-7405
Fax Number	:

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

Provider Enumeration Date	:	07/26/2017
Last Update Date	:	08/01/2025

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Directions to “ DIPSY TREJO LEAL ” Practice Location

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