Provider Demographics
NPI:1841904984
Name:BRIGHT LIGHT THERAPY SOLUTIONS
Entity type:Organization
Organization Name:BRIGHT LIGHT THERAPY SOLUTIONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MABELL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALCANTARA VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:305-323-6335
Mailing Address - Street 1:11021 SW 232ND TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6306
Mailing Address - Country:US
Mailing Address - Phone:305-323-6335
Mailing Address - Fax:
Practice Address - Street 1:11021 SW 232ND TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-6306
Practice Address - Country:US
Practice Address - Phone:305-323-6335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1497215222Medicaid