Provider Demographics
NPI:1376991646
Name:ALONSO CLEMENTE, LEIDY LAURA
Entity Type:Individual
Prefix:
First Name:LEIDY
Middle Name:LAURA
Last Name:ALONSO CLEMENTE
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 1:18825 NW 79TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5299
Mailing Address - Country:US
Mailing Address - Phone:786-409-9828
Mailing Address - Fax:
Practice Address - Street 1:18825 NW 79TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5299
Practice Address - Country:US
Practice Address - Phone:786-409-9828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst