Provider Demographics
NPI:1396021911
Name:LEON INFANTE, YADELY
Entity Type:Individual
Prefix:
First Name:YADELY
Middle Name:
Last Name:LEON INFANTE
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 1:12060 SW 129TH CT STE 104
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4582
Mailing Address - Country:US
Mailing Address - Phone:786-615-3349
Mailing Address - Fax:786-615-3299
Practice Address - Street 1:12060 SW 129TH CT STE 104
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4582
Practice Address - Country:US
Practice Address - Phone:786-615-3349
Practice Address - Fax:786-615-3299
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10632101YM0800X
FLBCBA-20-42493103K00000X
FLPY11514103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst