Provider Demographics
NPI:1720644016
Name:CHICO PIMENTEL, LEONARDO (BEHAVIOR ANALYST)
Entity Type:Individual
Prefix:
First Name:LEONARDO
Middle Name:
Last Name:CHICO PIMENTEL
Suffix:
Gender:M
Credentials:BEHAVIOR ANALYST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11174 SW 71ST LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2115
Mailing Address - Country:US
Mailing Address - Phone:786-817-5140
Mailing Address - Fax:
Practice Address - Street 1:9044 SW 153RD CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-2932
Practice Address - Country:US
Practice Address - Phone:786-817-5140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-22-13747106E00000X
FLRBT-18-67052106S00000X
FLBCBA1-23-64511103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBCBA1-23-64511OtherBACB