Healthcare Provider Details

I. General information

NPI: 1063260925
Provider Name (Legal Business Name): BEHAVIORAL BLUEPRINT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7969 RAMONA ST
MIRAMAR FL
33023-2459
US

IV. Provider business mailing address

20800 NW 14TH CT
MIAMI GARDENS FL
33169-3270
US

V. Phone/Fax

Practice location:
  • Phone: 786-810-1063
  • Fax:
Mailing address:
  • Phone: 786-810-1063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: DANIELA BARBARA MARINI
Title or Position: BCBA
Credential: MS, BCBA
Phone: 786-810-1063