Provider Demographics
NPI:1407527385
Name:RUBY BEACH BEHAVIORAL PEDIATRICS LLC
Entity Type:Organization
Organization Name:RUBY BEACH BEHAVIORAL PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-415-1609
Mailing Address - Street 1:12086 FORT CAROLINE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-2688
Mailing Address - Country:US
Mailing Address - Phone:904-415-1609
Mailing Address - Fax:
Practice Address - Street 1:12086 FORT CAROLINE RD STE 102
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-2688
Practice Address - Country:US
Practice Address - Phone:904-415-1609
Practice Address - Fax:904-485-8298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty