Provider Demographics
NPI:1114603578
Name:CASIANO, LEILANIE
Entity Type:Individual
Prefix:
First Name:LEILANIE
Middle Name:
Last Name:CASIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEILANIE
Other - Middle Name:
Other - Last Name:CASIANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, MS
Mailing Address - Street 1:351 AVE. HOSTOS EDIF. MEDICAL EMPORIUM
Mailing Address - Street 2:SUITE #203
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-376-7589
Mailing Address - Fax:
Practice Address - Street 1:351 AVE. HOSTOS EDIF. MEDICAL EMPORIUM
Practice Address - Street 2:SUITE #203
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-376-7589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6189103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist