MEDICARE: FLOURISHING MINDS ABA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1588363188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLOURISHING MINDS ABA

Provider Business Mailing Address
First Line	:	4 S ORANGE AVE # 285
Second Line	:
City	:	SOUTH ORANGE
State	:	NJ
Zip	:	07079-1702
Country	:	US
Telephone Number	:	862-250-4542
Fax Number	:

Provider Business Practice Location Address
First Line	:	1557 SPRINGFIELD AVE
Second Line	:
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-2413
Country	:	US
Telephone Number	:	862-250-4542
Fax Number	:

Authorized Official
Title or Position	:	BOARD CERTIFIED BEHAVIOR ANALYST
Name	:	LUZ C JEAN
Credential	:	BCBA
Telephone Number	:	862-250-4542

Provider Enumeration Date	:	03/02/2023
Last Update Date	:	03/02/2023

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