Provider Demographics
NPI:1831613280
Name:CORZO GONZALEZ, LEYDA CARIDAD (RBT)
Entity type:Individual
Prefix:
First Name:LEYDA
Middle Name:CARIDAD
Last Name:CORZO GONZALEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 NW 72ND AVE APT 32
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-4351
Mailing Address - Country:US
Mailing Address - Phone:786-525-3680
Mailing Address - Fax:
Practice Address - Street 1:235 NW 72ND AVE APT 32
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-4351
Practice Address - Country:US
Practice Address - Phone:786-525-3680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-27
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-19-9910106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty