Provider Demographics
NPI:1568225944
Name:BLUEBRIDGE BEHAVIORAL SERVICES INC
Entity Type:Organization
Organization Name:BLUEBRIDGE BEHAVIORAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YAHUMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-656-2477
Mailing Address - Street 1:7430 SW 41ST ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4491
Mailing Address - Country:US
Mailing Address - Phone:786-656-2477
Mailing Address - Fax:
Practice Address - Street 1:7430 SW 41ST ST STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4491
Practice Address - Country:US
Practice Address - Phone:786-656-2477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-30
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty