Provider Demographics
NPI:1659257590
Name:CRUZ FRADE, LEYDI
Entity type:Individual
Prefix:
First Name:LEYDI
Middle Name:
Last Name:CRUZ FRADE
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 1:1154 LEE BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-4852
Mailing Address - Country:US
Mailing Address - Phone:239-491-2603
Mailing Address - Fax:239-674-7392
Practice Address - Street 1:1154 LEE BLVD STE 6
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-4852
Practice Address - Country:US
Practice Address - Phone:239-491-2603
Practice Address - Fax:239-674-7392
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-14
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-461103106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician