Provider Demographics
NPI:1033579982
Name:BRIGHTLIGHT BEHEAVIOR GROUP LLC
Entity Type:Organization
Organization Name:BRIGHTLIGHT BEHEAVIOR GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:510-493-5491
Mailing Address - Street 1:424 ORANGE ST
Mailing Address - Street 2:301
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2961
Mailing Address - Country:US
Mailing Address - Phone:510-493-5491
Mailing Address - Fax:844-635-4257
Practice Address - Street 1:424 ORANGE ST
Practice Address - Street 2:301
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2961
Practice Address - Country:US
Practice Address - Phone:510-493-5491
Practice Address - Fax:844-635-4257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health