Provider Demographics
NPI:1184463127
Name:CORDERO MENA, LEIDY
Entity type:Individual
Prefix:
First Name:LEIDY
Middle Name:
Last Name:CORDERO MENA
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 1:6095 W 18TH AVE APT S114
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6124
Mailing Address - Country:US
Mailing Address - Phone:786-312-5036
Mailing Address - Fax:
Practice Address - Street 1:6095 W 18TH AVE APT S114
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6124
Practice Address - Country:US
Practice Address - Phone:786-312-5036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-342495106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician