Provider Demographics
NPI:1316717069
Name:STARLIGHT BEHAVIOR SERVICES LLC
Entity type:Organization
Organization Name:STARLIGHT BEHAVIOR SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIVIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUESTA RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:786-548-9615
Mailing Address - Street 1:6360 NW 114TH AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4566
Mailing Address - Country:US
Mailing Address - Phone:786-548-9615
Mailing Address - Fax:
Practice Address - Street 1:6360 NW 114TH AVE APT 205
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4566
Practice Address - Country:US
Practice Address - Phone:786-548-9615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health