MEDICARE: BLUE BLOCKS 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	103T00000X	Psychologist
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1528826500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE BLOCKS LLC

Provider Business Mailing Address
First Line	:	12240 INDIAN CREEK CT STE 100
Second Line	:
City	:	BELTSVILLE
State	:	MD
Zip	:	20705-1242
Country	:	US
Telephone Number	:	201-216-9500
Fax Number	:

Provider Business Practice Location Address
First Line	:	12240 INDIAN CREEK CT STE 100
Second Line	:
City	:	BELTSVILLE
State	:	MD
Zip	:	20705-1242
Country	:	US
Telephone Number	:	201-216-9500
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MS. MIRIAM NEWMARK
Credential	:	M.ED, BCBA, LBA
Telephone Number	:	201-216-9500

Provider Enumeration Date	:	03/13/2024
Last Update Date	:	03/28/2024

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Directions to “BLUE BLOCKS LLC ” Practice Location

Language	Start Address	Practice Location

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