Healthcare Provider Details

I. General information

NPI: 1437060134
Provider Name (Legal Business Name): BLOOMBRIDGE ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10045 BEACH VERBENA DR
RIVERVIEW FL
33578-5491
US

IV. Provider business mailing address

10045 BEACH VERBENA DR
RIVERVIEW FL
33578-5491
US

V. Phone/Fax

Practice location:
  • Phone: 813-533-0115
  • Fax: 813-533-0010
Mailing address:
  • Phone: 813-533-0115
  • Fax: 813-533-0010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ELIZABETH LORIE
Title or Position: OWNER
Credential:
Phone: 813-533-0115