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General NPI Number Information
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NPI Number | 1942077268
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Entity Type | Organization
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Legal Business Name | BLOSSOM ABA THERAPY VA
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Dates
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Enumeration Date | 12/06/2023
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Last Update Date | 12/14/2023
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Provider Practice Location Address
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Address Line | 4250 FAIRFAX DR
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City | ARLINGTON
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State | VA
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Zip | 22203-1665
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Country | US
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Telephone | 732-370-7505
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Fax |
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Provider Business Mailing Address
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Address Line | 575 ROUTE 70
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City | BRICK
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State | NJ
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Zip | 08723-4042
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Country | US
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Telephone | 917-538-7239
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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 | 917-538-7239
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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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