Provider Demographics
NPI:1013461201
Name:PUZZLE BUILDERS BEHAVIORAL THERAPY
Entity Type:Organization
Organization Name:PUZZLE BUILDERS BEHAVIORAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RBT THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:IRARRAGORRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-420-7138
Mailing Address - Street 1:4210 W 10TH LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7729
Mailing Address - Country:US
Mailing Address - Phone:786-420-7138
Mailing Address - Fax:
Practice Address - Street 1:4210 W 10TH LN
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7729
Practice Address - Country:US
Practice Address - Phone:786-420-7138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21886149Medicaid