Provider Demographics
NPI:1831821966
Name:BLUE CARE BEHAVIOR THERAPY LLC
Entity type:Organization
Organization Name:BLUE CARE BEHAVIOR THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANAY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-599-4901
Mailing Address - Street 1:5516 ROBERT SCOTT DR N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-5961
Mailing Address - Country:US
Mailing Address - Phone:904-662-7093
Mailing Address - Fax:904-506-4340
Practice Address - Street 1:5516 ROBERT SCOTT DR N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-5961
Practice Address - Country:US
Practice Address - Phone:904-662-7093
Practice Address - Fax:904-506-4340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty