Provider Demographics
NPI:1720960495
Name:BLUE LINE DUET
Entity type:Organization
Organization Name:BLUE LINE DUET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAROSELA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:305-209-6399
Mailing Address - Street 1:13611 S DIXIE HWY STE 545
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7258
Mailing Address - Country:US
Mailing Address - Phone:305-209-6399
Mailing Address - Fax:754-315-2751
Practice Address - Street 1:1125 NE 125TH ST STE 112
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5014
Practice Address - Country:US
Practice Address - Phone:305-209-6399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty