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General NPI Number Information
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NPI Number | 1326868928
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Entity Type | Organization
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Legal Business Name | BLUEBIRD BEHAVIOR THERAPY LLC
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 1777 TAMIAMI TRL STE 303-13
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-4128
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Country | US
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Telephone | 786-603-9214
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Fax |
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Provider Business Mailing Address
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Address Line | 1012 NE 34TH TER
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City | CAPE CORAL
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State | FL
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Zip | 33909-6423
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Country | US
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Telephone | 786-603-9214
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Fax |
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Authorized Official
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Title or Position | BCBA ANALYST
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Name | MAYDARA CABRERA
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Credential | BCBA
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Telephone | 786-603-9214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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