Healthcare Provider Details

I. General information

NPI: 1679146641
Provider Name (Legal Business Name): BUILDING BLOCKS BEHAVIOR THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 07/19/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10491 6 MILE CYPRESS PKWY STE 282
FORT MYERS FL
33966-6540
US

IV. Provider business mailing address

10491 6 MILE CYPRESS PKWY STE 282
FORT MYERS FL
33966-6540
US

V. Phone/Fax

Practice location:
  • Phone: 786-800-1633
  • Fax:
Mailing address:
  • Phone: 786-800-1633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: DAVID ALEJANDRO HERNANDEZ QUEVEDO
Title or Position: OWNER
Credential: RBT
Phone: 786-800-1633