Provider Demographics
NPI:1235976895
Name:GARNICA MORALES, LEISMY (RBT)
Entity type:Individual
Prefix:
First Name:LEISMY
Middle Name:
Last Name:GARNICA MORALES
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 1:100 LITTLE FLOWER CT APT 202
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2465
Mailing Address - Country:US
Mailing Address - Phone:910-214-9466
Mailing Address - Fax:
Practice Address - Street 1:100 LITTLE FLOWER CT APT 202
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2465
Practice Address - Country:US
Practice Address - Phone:910-214-9466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-351400106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty