Provider Demographics
NPI:1003305582
Name:ALVAREZ LAURENTI, LEISBET REINA
Entity Type:Individual
Prefix:
First Name:LEISBET
Middle Name:REINA
Last Name:ALVAREZ LAURENTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2346 W 66TH PL APT 301
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-3973
Mailing Address - Country:US
Mailing Address - Phone:786-256-5185
Mailing Address - Fax:
Practice Address - Street 1:175 FOUNTAINBLEAU BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-7018
Practice Address - Country:US
Practice Address - Phone:786-564-7897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician