Provider Demographics
NPI:1952054934
Name:MADRIGAL, LEONOR D (RBT)
Entity Type:Individual
Prefix:
First Name:LEONOR
Middle Name:D
Last Name:MADRIGAL
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 1:1406 NW 32ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-6147
Mailing Address - Country:US
Mailing Address - Phone:305-901-9175
Mailing Address - Fax:
Practice Address - Street 1:1406 NW 32ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-6147
Practice Address - Country:US
Practice Address - Phone:305-901-9175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-201541106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-22-201541OtherREGISTERED BEHAVIOR TECHNICIAN