Provider Demographics
NPI:1831913300
Name:VALLE BLUE THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:VALLE BLUE THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAINERYS
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:786-837-7404
Mailing Address - Street 1:14261 SW 120TH ST STE 108
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7273
Mailing Address - Country:US
Mailing Address - Phone:786-837-7404
Mailing Address - Fax:
Practice Address - Street 1:14261 SW 120TH ST STE 108
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7273
Practice Address - Country:US
Practice Address - Phone:786-837-7404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-12
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1376701417Medicaid