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NPI Code Detail

MEDICARE: BLOSSOM APPLIED BEHAVIOR ANALYSIS THERAPY P.L.L.C

MEDICARE: BLOSSOM APPLIED BEHAVIOR ANALYSIS THERAPY P.L.L.C
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1477382174
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLOSSOM APPLIED BEHAVIOR ANALYSIS THERAPY P.L.L.C
Provider Business Mailing Address
First Line : 115 MONTROSE AVE
Second Line :
City : BUFFALO
State : NY
Zip : 14214-1248
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 115 MONTROSE AVE
Second Line :
City : BUFFALO
State : NY
Zip : 14214-1248
Country : US
Telephone Number : 716-382-3585
Fax Number : 716-758-4090
Authorized Official
Title or Position : OWNER
Name : TIA PALMER
Credential :
Telephone Number : 716-253-0153
Provider Enumeration Date : 07/31/2024
Last Update Date : 02/24/2026

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