Provider Demographics
NPI:1043926553
Name:YEZANA KIDS THERAPY LLC
Entity type:Organization
Organization Name:YEZANA KIDS THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GULENKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUERGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-776-0296
Mailing Address - Street 1:2255 GLADES ROAD
Mailing Address - Street 2:SUITE 324A
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431
Mailing Address - Country:US
Mailing Address - Phone:305-776-0296
Mailing Address - Fax:561-269-6894
Practice Address - Street 1:2255 GLADES ROAD
Practice Address - Street 2:SUITE 324A
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431
Practice Address - Country:US
Practice Address - Phone:305-776-0296
Practice Address - Fax:561-269-6894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-27
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty