MEDICARE: BUILDING BLOCKS BEHAVIOR THERAPY SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	106E00000X	Assistant Behavior Analyst
2	106S00000X	Behavior Technician
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1679146641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUILDING BLOCKS BEHAVIOR THERAPY SERVICES LLC

Provider Business Mailing Address
First Line	:	10491 6 MILE CYPRESS PKWY STE 282
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-6540
Country	:	US
Telephone Number	:	786-800-1633
Fax Number	:

Provider Business Practice Location Address
First Line	:	10491 6 MILE CYPRESS PKWY STE 282
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-6540
Country	:	US
Telephone Number	:	786-800-1633
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID ALEJANDRO HERNANDEZ QUEVEDO
Credential	:	RBT
Telephone Number	:	786-800-1633

Provider Enumeration Date	:	07/19/2021
Last Update Date	:	07/19/2021

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