Provider Demographics
NPI:1760889117
Name:PROJECT BRILLIANCE
Entity Type:Organization
Organization Name:PROJECT BRILLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:561-508-6122
Mailing Address - Street 1:9000 BURMA RD
Mailing Address - Street 2:109
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33403-1606
Mailing Address - Country:US
Mailing Address - Phone:561-508-6122
Mailing Address - Fax:
Practice Address - Street 1:9000 BURMA ROAD
Practice Address - Street 2:SUITE 109
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33403-3340
Practice Address - Country:US
Practice Address - Phone:561-508-6122
Practice Address - Fax:844-380-3491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1073722103K00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty