Provider Demographics
NPI:1043876980
Name:LEON, SUSANA
Entity Type:Individual
Prefix:MISS
First Name:SUSANA
Middle Name:
Last Name:LEON
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 1:457 NW 57TH AVE APT 27
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-4864
Mailing Address - Country:US
Mailing Address - Phone:305-930-3733
Mailing Address - Fax:305-262-3420
Practice Address - Street 1:457 NW 57TH AVE APT 27
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-4864
Practice Address - Country:US
Practice Address - Phone:305-930-3733
Practice Address - Fax:305-262-3420
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker