Provider Demographics
NPI:1689365140
Name:BLUE DRAGON ABA, LLC
Entity Type:Organization
Organization Name:BLUE DRAGON ABA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:GERSHON
Authorized Official - Middle Name:
Authorized Official - Last Name:FINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-521-1587
Mailing Address - Street 1:3921 ALTON RD UNIT 107
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3852
Mailing Address - Country:US
Mailing Address - Phone:786-521-1587
Mailing Address - Fax:
Practice Address - Street 1:2111 S 67TH ST STE 300
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-2882
Practice Address - Country:US
Practice Address - Phone:402-819-5140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty