Provider Demographics
NPI:1053188292
Name:BRIGHT BLUE THERAPY CORP
Entity type:Organization
Organization Name:BRIGHT BLUE THERAPY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAZARO
Authorized Official - Middle Name:FRANCISCO
Authorized Official - Last Name:JUNCO RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-365-8864
Mailing Address - Street 1:111 SW 3RD ST STE 608
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-1926
Mailing Address - Country:US
Mailing Address - Phone:786-365-8864
Mailing Address - Fax:786-365-8864
Practice Address - Street 1:111 SW 3RD ST STE 608
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-1926
Practice Address - Country:US
Practice Address - Phone:786-365-8864
Practice Address - Fax:786-365-8864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty