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General NPI Number Information
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NPI Number | 1912721945
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Entity Type | Organization
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Legal Business Name | SKY BLUE THERAPY CENTER, INC
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Dates
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Enumeration Date | 11/15/2024
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 10300 SW 72ND ST STE 135
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City | MIAMI
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State | FL
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Zip | 33173-3038
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Country | US
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Telephone | 786-631-3136
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Fax |
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Provider Business Mailing Address
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Address Line | 7351 SW 147TH CT
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City | MIAMI
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State | FL
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Zip | 33193-1118
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAZARA M ALVAREZ CASTILLO
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Credential |
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Telephone | 786-532-0892
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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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