=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104737964
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLOOMING HOPE BEHAVIORAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2026
-----------------------------------------------------
Last Update Date | 09/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10570 S US HIGHWAY 1 STE 200-28
-----------------------------------------------------
City | PORT SAINT LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34952-5606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-200-8033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10570 S US HIGHWAY 1 STE 200-28
-----------------------------------------------------
City | PORT SAINT LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34952-5606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-200-8033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CINTHYA CLAUDIA NEGRIN MORALES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-200-8033
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------