Healthcare Provider Details

I. General information

NPI: 1003747262
Provider Name (Legal Business Name): BLACKROCK BEHAVIOR GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4154 MOUNTCASTLE WAY
SAN JOSE CA
95136-1754
US

IV. Provider business mailing address

4154 MOUNTCASTLE WAY
SAN JOSE CA
95136-1754
US

V. Phone/Fax

Practice location:
  • Phone: 408-891-0349
  • Fax:
Mailing address:
  • Phone: 408-891-0349
  • 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: TROY MARTIN BURG
Title or Position: CONSUMER BEHAVIOR & OBM CONSULTANT
Credential: BCBA, LSSBB,CBA, IBA
Phone: 408-891-0349