Provider Demographics
NPI:1790261709
Name:LEONARD, JENNIFER DORREN (BEHAVIOR TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DORREN
Last Name:LEONARD
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 LINCOLN ST APT 102
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-3957
Mailing Address - Country:US
Mailing Address - Phone:786-757-9072
Mailing Address - Fax:
Practice Address - Street 1:2521 LINCOLN ST APT 102
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-3957
Practice Address - Country:US
Practice Address - Phone:786-757-9072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-55610106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician