Provider Demographics
NPI:1750716056
Name:SIMON, LEANNE BURNETT (BCABA)
Entity type:Individual
Prefix:MS
First Name:LEANNE
Middle Name:BURNETT
Last Name:SIMON
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 36TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-1433
Mailing Address - Country:US
Mailing Address - Phone:845-521-5830
Mailing Address - Fax:
Practice Address - Street 1:145 36TH AVE NE
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-1433
Practice Address - Country:US
Practice Address - Phone:845-521-5830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst