Provider Demographics
NPI:1396203733
Name:LEON, MADELYN (RBT)
Entity Type:Individual
Prefix:MRS
First Name:MADELYN
Middle Name:
Last Name:LEON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4482 SW 164TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5283
Mailing Address - Country:US
Mailing Address - Phone:786-352-3245
Mailing Address - Fax:
Practice Address - Street 1:4482 SW 164TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5283
Practice Address - Country:US
Practice Address - Phone:786-352-3245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician