Provider Demographics
NPI:1326823642
Name:BLUE ANGELS BEHAVIOR THERAPY LLC
Entity Type:Organization
Organization Name:BLUE ANGELS BEHAVIOR THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENCOMO REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-717-8011
Mailing Address - Street 1:6011 W 16TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6213
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6011 W 16TH AVE STE B
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6213
Practice Address - Country:US
Practice Address - Phone:786-717-8011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty