Provider Demographics
NPI:1205615424
Name:GUTIERREZ-SIMANCAS, LEIDYS (RBT)
Entity type:Individual
Prefix:MRS
First Name:LEIDYS
Middle Name:
Last Name:GUTIERREZ-SIMANCAS
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 1:1860 NW 68TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-7458
Mailing Address - Country:US
Mailing Address - Phone:305-742-1838
Mailing Address - Fax:
Practice Address - Street 1:1860 NW 68TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-7458
Practice Address - Country:US
Practice Address - Phone:305-742-1838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty