Provider Demographics
NPI:1770347064
Name:HERRERA ESPINOSA, LEIDY MARIAN
Entity type:Individual
Prefix:
First Name:LEIDY
Middle Name:MARIAN
Last Name:HERRERA ESPINOSA
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 1:2607 66TH ST W
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-0875
Mailing Address - Country:US
Mailing Address - Phone:239-222-6615
Mailing Address - Fax:
Practice Address - Street 1:2607 66TH ST W
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-0875
Practice Address - Country:US
Practice Address - Phone:239-222-6615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician