Provider Demographics
NPI:1396544086
Name:MORERA LEON, MADELYN (RBT-24-400569)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:
Last Name:MORERA LEON
Suffix:
Gender:F
Credentials:RBT-24-400569
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 NW 9TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-7171
Mailing Address - Country:US
Mailing Address - Phone:239-898-4094
Mailing Address - Fax:
Practice Address - Street 1:2200 NW 9TH TER
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33993-7171
Practice Address - Country:US
Practice Address - Phone:239-898-4094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-400569106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician