Provider Demographics
NPI:1720736242
Name:BLUE SWAN LLC
Entity Type:Organization
Organization Name:BLUE SWAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:DIANELYS
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA,MS
Authorized Official - Phone:786-338-0063
Mailing Address - Street 1:1071 SW 124TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-2458
Mailing Address - Country:US
Mailing Address - Phone:786-338-0063
Mailing Address - Fax:
Practice Address - Street 1:1071 SW 124TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-2458
Practice Address - Country:US
Practice Address - Phone:786-338-0063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty