Organization Active NPI

Ocean Blue Behavior Therapy Inc

  • Behavior Analyst
  • Lakeland, FL
National Provider Identifier
1114790227
Registry record updated Jan 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
OCEAN BLUE BEHAVIOR THERAPY INC
Practice address
1137 Bartow Rd Ste 207
Lakeland, FL 33801-5828
Phone
(786) 278-8655
Fax
(863) 583-8955
NPI assigned
Oct 31, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Maria Eugenia Acosta Dominguez, BCBA, ITDS.NPI 1558957977
Title
Owner
Phone
(786) 278-8655

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X Primary
Early Intervention Provider Agency 252Y00000X

Addresses

Primary practice location

1137 Bartow Rd Ste 207
Lakeland, FL 33801-5828

Mailing address

4515 Ashford Dr
Winter Haven, FL 33880-1148
Phone (786) 278-8655

National Provider Directory

National Provider Directory

Locations

1137 Bartow Rd
Ste 207
Lakeland, FL 33801
Phone (786) 278-8655

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1698710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737590400000",
    "number": "1114790227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4515 ASHFORD DR",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338801148",
            "telephone_number": "786-278-8655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1137 BARTOW RD STE 207",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338015828",
            "telephone_number": "786-278-8655",
            "fax_number": "863-583-8955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCEAN BLUE BEHAVIOR THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-31",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A",
        "authorized_official_last_name": "ACOSTA DOMINGUEZ",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "EUGENIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "786-278-8655",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BCBA, ITDS."
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.