Provider Demographics
NPI:1922694470
Name:LEIVA, JULIE DESTINY (RBT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:DESTINY
Last Name:LEIVA
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 1:4020 SW 111TH AVE STE A202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-4752
Mailing Address - Country:US
Mailing Address - Phone:305-724-7595
Mailing Address - Fax:
Practice Address - Street 1:4020 SW 111TH AVE STE A202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-4752
Practice Address - Country:US
Practice Address - Phone:305-724-7595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FLRBT-20-114459106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician