Healthcare Provider Details

I. General information

NPI: 1669325544
Provider Name (Legal Business Name): BLOOM PATH ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 S CONGRESS AVE C200-E
PALM SPRINGS FL
33461
US

IV. Provider business mailing address

3175 S CONGRESS AVE C200-E
PALM SPRINGS FL
33461
US

V. Phone/Fax

Practice location:
  • Phone: 561-201-9132
  • Fax: 561-658-1287
Mailing address:
  • Phone:
  • Fax: 561-658-1287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARLENE ZARAGOZA
Title or Position: VP
Credential:
Phone: 561-255-9808