Healthcare Provider Details

I. General information

NPI: 1790542926
Provider Name (Legal Business Name): SWEET BLOOM ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 GODWIN AVE STE 300
MIDLAND PARK NJ
07432-1959
US

IV. Provider business mailing address

44 GODWIN AVE STE 300
MIDLAND PARK NJ
07432-1959
US

V. Phone/Fax

Practice location:
  • Phone: 201-429-2540
  • Fax: 201-429-2851
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ENHEA OH
Title or Position: FOUNDER
Credential: MA, BCBA
Phone: 201-961-4665