Provider Demographics
NPI:1821523481
Name:DE LEON GUERRA, GIDELIN (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:GIDELIN
Middle Name:
Last Name:DE LEON GUERRA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6711 SW 129TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-1303
Mailing Address - Country:US
Mailing Address - Phone:178-676-5755
Mailing Address - Fax:
Practice Address - Street 1:6711 SW 129TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-1303
Practice Address - Country:US
Practice Address - Phone:178-676-5755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-54636106S00000X
FL1-22-59270103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician