Healthcare Provider Details

I. General information

NPI: 1407426083
Provider Name (Legal Business Name): BRIGHTLIGHT BEHAVIORAL SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16464 SW 84TH ST
MIAMI FL
33193-5735
US

IV. Provider business mailing address

16464 SW 84TH ST
MIAMI FL
33193-5735
US

V. Phone/Fax

Practice location:
  • Phone: 305-979-7309
  • Fax:
Mailing address:
  • Phone: 305-979-7309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANIBIS BROCHE
Title or Position: PRESIDENT
Credential:
Phone: 305-979-7309