Provider Demographics
NPI:1801651419
Name:CORREAL, LEIDY
Entity type:Individual
Prefix:
First Name:LEIDY
Middle Name:
Last Name:CORREAL
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 1:7808 NW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6302
Mailing Address - Country:US
Mailing Address - Phone:954-496-2093
Mailing Address - Fax:
Practice Address - Street 1:7808 NW 41ST ST
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6302
Practice Address - Country:US
Practice Address - Phone:954-496-2093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician