Provider Demographics
NPI:1568230605
Name:LEYVA GONZALEZ, MELISA (RBT-23-316418)
Entity Type:Individual
Prefix:
First Name:MELISA
Middle Name:
Last Name:LEYVA GONZALEZ
Suffix:
Gender:F
Credentials:RBT-23-316418
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4126 NW 88TH AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-1808
Mailing Address - Country:US
Mailing Address - Phone:754-317-5688
Mailing Address - Fax:
Practice Address - Street 1:4126 NW 88TH AVE APT 101
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-1808
Practice Address - Country:US
Practice Address - Phone:754-317-5688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-316418106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician