MEDICARE: BLUE CARE BEHAVIOR THERAPY LLC

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	103K00000X	Behavior Analyst

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	:	1831821966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE CARE BEHAVIOR THERAPY LLC

Provider Business Mailing Address
First Line	:	5516 ROBERT SCOTT DR N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-5961
Country	:	US
Telephone Number	:	904-662-7093
Fax Number	:	904-506-4340

Provider Business Practice Location Address
First Line	:	5516 ROBERT SCOTT DR N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-5961
Country	:	US
Telephone Number	:	904-662-7093
Fax Number	:	904-506-4340

Authorized Official
Title or Position	:	OWNER
Name	:	ANAY QUINTERO
Credential	:
Telephone Number	:	786-599-4901

Provider Enumeration Date	:	06/28/2022
Last Update Date	:	06/09/2026

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