Provider Demographics
NPI:1265672737
Name:GREEN, LESLEY FAYE (MS, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:FAYE
Last Name:GREEN
Suffix:
Gender:F
Credentials:MS, BCBA
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Other - First Name:
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Mailing Address - Street 1:1010 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3529
Mailing Address - Country:US
Mailing Address - Phone:321-281-3840
Mailing Address - Fax:321-281-3887
Practice Address - Street 1:1010 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3529
Practice Address - Country:US
Practice Address - Phone:321-281-3840
Practice Address - Fax:321-281-3887
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL1-05-2594103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst