Healthcare Provider Details

I. General information

NPI: 1972440832
Provider Name (Legal Business Name): NEUROBLOOM DEVELOPMENT CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W 4TH ST STE 102
CLAREMONT CA
91711-4707
US

IV. Provider business mailing address

201 W 4TH ST STE 102
CLAREMONT CA
91711-4707
US

V. Phone/Fax

Practice location:
  • Phone: 213-507-1597
  • Fax:
Mailing address:
  • Phone: 213-507-1597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: BETTY TIA-CONGER
Title or Position: OWNER/BCBA
Credential: M.A., B.C.B.A.
Phone: 213-507-1597