Provider Demographics
NPI:1588549802
Name:LEYVA GARAY, JORGE JASSAN
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:JASSAN
Last Name:LEYVA GARAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2476 TIMBER FOREST DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-3625
Mailing Address - Country:US
Mailing Address - Phone:561-971-5444
Mailing Address - Fax:
Practice Address - Street 1:2476 TIMBER FOREST DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-3625
Practice Address - Country:US
Practice Address - Phone:561-971-5444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-460086106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician