MEDICARE: BLYDA ARRECHEA CORUNA BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	104100000X	Social Worker
3	106S00000X	Behavior Technician		FL
4	103K00000X	Behavior Analyst	1-21-52330	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215356886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLYDA ARRECHEA CORUNA BCBA

Provider Business Mailing Address
First Line	:	6738 KINGSMOOR WAY
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-6520
Country	:	US
Telephone Number	:	239-440-9787
Fax Number	:

Provider Business Practice Location Address
First Line	:	6738 KINGSMOOR WAY
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-6520
Country	:	US
Telephone Number	:	239-440-9787
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2014
Last Update Date	:	10/05/2021

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