Provider Demographics
NPI:1982476537
Name:ADRIAN BLUE THERAPY CENTER LLC
Entity type:Organization
Organization Name:ADRIAN BLUE THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ LLANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-246-5462
Mailing Address - Street 1:3220 SW 107TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3610
Mailing Address - Country:US
Mailing Address - Phone:786-246-5462
Mailing Address - Fax:
Practice Address - Street 1:3220 SW 107TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3610
Practice Address - Country:US
Practice Address - Phone:786-246-5462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-26
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty