Provider Demographics
NPI:1083314652
Name:BRILLIANT BLUE BEHAVIOR ANALYSIS LLC
Entity Type:Organization
Organization Name:BRILLIANT BLUE BEHAVIOR ANALYSIS LLC
Other - Org Name:BRILLIANT BLUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIVIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RBT
Authorized Official - Phone:786-509-3700
Mailing Address - Street 1:13100 SW 262ND LN
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8924
Mailing Address - Country:US
Mailing Address - Phone:786-404-3479
Mailing Address - Fax:786-404-3480
Practice Address - Street 1:100 NE 15TH ST STE 209
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4581
Practice Address - Country:US
Practice Address - Phone:786-509-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-03
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty