Provider Demographics
NPI:1891067351
Name:DELEON, JUDITH E (MS)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:E
Last Name:DELEON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12001 AVALON LAKE DR APT 212
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7376
Mailing Address - Country:US
Mailing Address - Phone:321-527-1101
Mailing Address - Fax:
Practice Address - Street 1:12001 AVALON LAKE DR APT 212
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7376
Practice Address - Country:US
Practice Address - Phone:321-527-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health