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General NPI Number Information
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NPI Number | 1831821966
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Entity Type | Organization
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Legal Business Name | BLUE CARE BEHAVIOR THERAPY LLC
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Dates
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Enumeration Date | 06/28/2022
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Last Update Date | 06/28/2022
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Provider Practice Location Address
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Address Line | 5516 ROBERT SCOTT DR N
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City | JACKSONVILLE
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State | FL
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Zip | 32207-5961
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Country | US
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Telephone | 904-662-7093
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Fax | 904-506-4340
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Provider Business Mailing Address
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Address Line | 5516 ROBERT SCOTT DR N
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City | JACKSONVILLE
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State | FL
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Zip | 32207-5961
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Country | US
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Telephone | 904-662-7093
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Fax | 904-506-4340
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Authorized Official
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Title or Position | OWNER
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Name | ANAY QUINTORO
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Credential |
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Telephone | 786-599-4901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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