Provider Demographics
NPI:1073365557
Name:JOMARRON SIMON, LEIDY DE LA CARIDAD
Entity Type:Individual
Prefix:
First Name:LEIDY
Middle Name:DE LA CARIDAD
Last Name:JOMARRON SIMON
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 1:7330 SW 13TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5312
Mailing Address - Country:US
Mailing Address - Phone:786-909-5933
Mailing Address - Fax:
Practice Address - Street 1:7330 SW 13TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-5312
Practice Address - Country:US
Practice Address - Phone:786-909-5933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-334663103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst