Provider Demographics
NPI:1306274865
Name:LEON IGLESIAS, LISSETTE (PSYD)
Entity type:Individual
Prefix:DR
First Name:LISSETTE
Middle Name:
Last Name:LEON IGLESIAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9840 SANDALFOOT BLVD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-6645
Mailing Address - Country:US
Mailing Address - Phone:561-910-1862
Mailing Address - Fax:
Practice Address - Street 1:9840 SANDALFOOT BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-6645
Practice Address - Country:US
Practice Address - Phone:561-910-1862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-21
Last Update Date:2016-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9557103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical