MEDICARE: BLUE BUTTERFLY BEHAVIOR CENTER LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1750064655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE BUTTERFLY BEHAVIOR CENTER LLC

Provider Business Mailing Address
First Line	:	6721 ALLEN ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-1807
Country	:	US
Telephone Number	:	786-805-8076
Fax Number	:	786-386-0934

Provider Business Practice Location Address
First Line	:	6721 ALLEN ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-1807
Country	:	US
Telephone Number	:	786-805-8076
Fax Number	:	786-386-0934

Authorized Official
Title or Position	:	CEO
Name	:	YUDY AGUILA CUDEIRO
Credential	:	BCBA 1-21-51502
Telephone Number	:	786-805-8076

Provider Enumeration Date	:	08/08/2023
Last Update Date	:	04/16/2024

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