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General NPI Number Information
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NPI Number | 1902538333
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Entity Type | Organization
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Legal Business Name | BLOOM BEHAVIORAL CONNECTIONS LLC
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Dates
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Enumeration Date | 06/24/2022
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 312 S CHADWICK ST # 2R
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City | PHILADELPHIA
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State | PA
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Zip | 19103-6706
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Country | US
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Telephone | 267-467-6599
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Fax | 213-603-4381
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Provider Business Mailing Address
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Address Line | 13 SUMMIT SQUARE CTR STE 450
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City | LANGHORNE
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State | PA
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Zip | 19047-1078
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Country | US
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Telephone | 267-467-6599
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Fax | 213-603-4381
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Authorized Official
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Title or Position | OWNER
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Name | DANA SULLIVAN
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Credential | BCBA
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Telephone | 732-453-4772
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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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