Provider Demographics
NPI:1962859298
Name:JOANNA LEAL
Entity Type:Organization
Organization Name:JOANNA LEAL
Other - Org Name:JOANNA LEAL BCBA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAL
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:415-741-8643
Mailing Address - Street 1:16792 TALISMAN LN APT 205
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-3118
Mailing Address - Country:US
Mailing Address - Phone:415-741-8643
Mailing Address - Fax:
Practice Address - Street 1:16792 TALISMAN LN APT 205
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-3118
Practice Address - Country:US
Practice Address - Phone:415-741-8643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-14386103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty