Provider Demographics
NPI:1447068978
Name:MARIN SIABATO, LEIDY PAOLA
Entity type:Individual
Prefix:
First Name:LEIDY
Middle Name:PAOLA
Last Name:MARIN SIABATO
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 1:801 W LANCASTER RD APT G92
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-5894
Mailing Address - Country:US
Mailing Address - Phone:407-283-8270
Mailing Address - Fax:
Practice Address - Street 1:801 W LANCASTER RD APT G92
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5894
Practice Address - Country:US
Practice Address - Phone:407-283-8270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLM652-535-87-515-0106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician