Provider Demographics
NPI:1083314652
Name:BRILLIANT BLUE BEHAVIOR ANALYSIS LLC
Entity type:Organization
Organization Name:BRILLIANT BLUE BEHAVIOR ANALYSIS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIVIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-509-3700
Mailing Address - Street 1:13100 SW 262ND LN
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8924
Mailing Address - Country:US
Mailing Address - Phone:786-404-3114
Mailing Address - Fax:786-404-3124
Practice Address - Street 1:13100 SW 262ND LN
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8924
Practice Address - Country:US
Practice Address - Phone:786-404-3114
Practice Address - Fax:786-404-3124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-03
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty