Provider Demographics
NPI:1023886140
Name:CRESPO YRIARTE, LEIDY MADAY
Entity type:Individual
Prefix:
First Name:LEIDY
Middle Name:MADAY
Last Name:CRESPO YRIARTE
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 1:6940 HARDING ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3824
Mailing Address - Country:US
Mailing Address - Phone:786-526-7803
Mailing Address - Fax:
Practice Address - Street 1:6940 HARDING ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-3824
Practice Address - Country:US
Practice Address - Phone:786-526-7803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-314423106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty