Provider Demographics
NPI:1316756638
Name:VILLALONGA, LEIDYS (RBT)
Entity type:Individual
Prefix:MISS
First Name:LEIDYS
Middle Name:
Last Name:VILLALONGA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 CAROLINE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33413-1825
Mailing Address - Country:US
Mailing Address - Phone:786-539-6400
Mailing Address - Fax:
Practice Address - Street 1:408 CAROLINE AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33413-1825
Practice Address - Country:US
Practice Address - Phone:786-539-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-01
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24401718106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician