Provider Demographics
NPI:1235900150
Name:BLUE WINGS THERAPY INC
Entity Type:Organization
Organization Name:BLUE WINGS THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KERVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYA MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-635-9097
Mailing Address - Street 1:3141 S MILITARY TRL STE 114
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-2133
Mailing Address - Country:US
Mailing Address - Phone:561-635-9097
Mailing Address - Fax:
Practice Address - Street 1:3141 S MILITARY TRL STE 114
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-2133
Practice Address - Country:US
Practice Address - Phone:561-635-9097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty