Provider Demographics
NPI:1881367613
Name:TODISCO, LESLIE ANN (RBT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:TODISCO
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 1:4329 WELLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-2454
Mailing Address - Country:US
Mailing Address - Phone:321-914-8465
Mailing Address - Fax:407-960-3009
Practice Address - Street 1:4329 WELLINGTON RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2454
Practice Address - Country:US
Practice Address - Phone:321-914-8465
Practice Address - Fax:407-960-3009
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-177231106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician