Provider Demographics
NPI:1114790227
Name:OCEAN BLUE BEHAVIOR THERAPY INC
Entity type:Organization
Organization Name:OCEAN BLUE BEHAVIOR THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:EUGENIA
Authorized Official - Last Name:ACOSTA DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, ITDS
Authorized Official - Phone:786-278-8655
Mailing Address - Street 1:4515 ASHFORD DR
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-1148
Mailing Address - Country:US
Mailing Address - Phone:786-278-8655
Mailing Address - Fax:
Practice Address - Street 1:1137 BARTOW RD STE 207
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5828
Practice Address - Country:US
Practice Address - Phone:786-278-8655
Practice Address - Fax:863-583-8955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty