Provider Demographics
NPI:1609385277
Name:VALDES, LEISY CARIDAD
Entity type:Individual
Prefix:
First Name:LEISY
Middle Name:CARIDAD
Last Name:VALDES
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 1:19380 COLLINS AVE APT 1621
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2457
Mailing Address - Country:US
Mailing Address - Phone:305-915-8428
Mailing Address - Fax:
Practice Address - Street 1:19380 COLLINS AVE APT 1621
Practice Address - Street 2:
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-2457
Practice Address - Country:US
Practice Address - Phone:305-915-8428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FLBCABA-0-22-14037106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022614500Medicaid