Provider Demographics
NPI:1578358255
Name:LEIVA JIMENEZ, LIEN
Entity type:Individual
Prefix:
First Name:LIEN
Middle Name:
Last Name:LEIVA JIMENEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6143 108TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-2547
Mailing Address - Country:US
Mailing Address - Phone:727-383-7056
Mailing Address - Fax:
Practice Address - Street 1:7212 CURRY FORD RD BLDG 3
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-5806
Practice Address - Country:US
Practice Address - Phone:786-303-8649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-12
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-425601106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician