Provider Demographics
NPI:1295595320
Name:BLUE STAR ABA THERAPY, LLC
Entity type:Organization
Organization Name:BLUE STAR ABA THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:INFANTE ROCUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-979-6788
Mailing Address - Street 1:12985 SW 130TH CT # 107-4
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5312
Mailing Address - Country:US
Mailing Address - Phone:305-979-6788
Mailing Address - Fax:
Practice Address - Street 1:12985 SW 130TH CT # 107-4
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5312
Practice Address - Country:US
Practice Address - Phone:305-979-6788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty