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General NPI Number Information
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NPI Number | 1952265019
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Entity Type | Organization
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Legal Business Name | BLOOMING HEARTS BEHAVIORAL HEALTH AND CHILD DEVELOPMENT
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Dates
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Enumeration Date | 12/12/2025
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 7741 SURREYWOOD PL
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City | CHARLOTTE
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State | NC
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Zip | 28270-2158
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Country | US
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Telephone | 786-606-8011
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Fax |
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Provider Business Mailing Address
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Address Line | 7741 SURREYWOOD PL
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City | CHARLOTTE
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State | NC
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Zip | 28270-2158
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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 | PRESIDENT
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Name | JESSICA ANDINO
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Credential | BCBA, LBA
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Telephone | 786-606-8011
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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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