Provider Demographics
NPI:1023832540
Name:ROMERO, LESLEY
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:ROMERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5077 NW 7TH ST APT 406
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3461
Mailing Address - Country:US
Mailing Address - Phone:786-357-1068
Mailing Address - Fax:
Practice Address - Street 1:1501 ROBERT J CONLAN BLVD NE STE 120-10
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3502
Practice Address - Country:US
Practice Address - Phone:321-677-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst