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General NPI Number Information
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NPI Number | 1245127117
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Entity Type | Organization
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Legal Business Name | BLOSSOM ABA THERAPY MD LLC
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 5011 ARBUTUS AVE # 1017
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City | BALTIMORE
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State | MD
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Zip | 21215-5723
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Country | US
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Telephone | 857-327-5283
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Fax |
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Provider Business Mailing Address
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Address Line | 229 ROUTE 70 STE 100
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City | TOMS RIVER
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State | NJ
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Zip | 08755-1026
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHAD KAUFMAN
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Credential |
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Telephone | 857-327-5283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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