Provider Demographics
NPI:1467162123
Name:BLUE SEA THERAPY SERVICES INC
Entity Type:Organization
Organization Name:BLUE SEA THERAPY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HORTENCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-663-9503
Mailing Address - Street 1:8965 NW 112TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4575
Mailing Address - Country:US
Mailing Address - Phone:786-663-9503
Mailing Address - Fax:
Practice Address - Street 1:8965 NW 112TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4575
Practice Address - Country:US
Practice Address - Phone:786-663-9503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty