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General NPI Number Information
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NPI Number | 1619857851
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Entity Type | Organization
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Legal Business Name | BRIGHT PATH PEDIATRIC CENTER, LLC
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 1860 SW FOUNTAINVIEW BLVD STE 37
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34986-4535
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Country | US
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Telephone | 561-371-1475
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Fax | 772-200-4373
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Provider Business Mailing Address
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Address Line | 1860 SW FOUNTAINVIEW BLVD STE 37
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34986-4535
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Country | US
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Telephone | 561-371-1475
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Fax | 772-200-4373
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHELLE REYES
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Credential | DBH, BCBA, LBA
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Telephone | 561-371-1475
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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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