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General NPI Number Information
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NPI Number | 1053181966
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Entity Type | Organization
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Legal Business Name | INBLOOM AUTISM SERVICES
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Dates
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Enumeration Date | 01/03/2024
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Last Update Date | 01/03/2024
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Provider Practice Location Address
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Address Line | 5400 S UNIVERSITY DR STE 502
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City | DAVIE
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State | FL
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Zip | 33328-5313
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Country | US
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Telephone | 888-754-0398
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Fax |
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Provider Business Mailing Address
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Address Line | 3940 SW 186TH TER
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City | MIRAMAR
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State | FL
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Zip | 33029
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Country | US
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Telephone | 954-579-8060
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Fax |
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Authorized Official
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Title or Position | RBT
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Name | DANIEL DEMARIN
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Credential |
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Telephone | 954-579-8060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number |
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License Number State |
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