MEDICARE: BLOOM BEHAVIOR SERVICES LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790291649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOM BEHAVIOR SERVICES LLC

Provider Business Mailing Address
First Line	:	6239 EDGEWATER DR STE N4
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-4736
Country	:	US
Telephone Number	:	407-900-5532
Fax Number	:	321-244-0645

Provider Business Practice Location Address
First Line	:	6239 EDGEWATER DR STE N4
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-4736
Country	:	US
Telephone Number	:	407-900-5532
Fax Number	:	321-244-0645

Authorized Official
Title or Position	:	OWNER
Name	:	MIA RICHARDS
Credential	:	BCBA
Telephone Number	:	407-758-4948

Provider Enumeration Date	:	12/14/2017
Last Update Date	:	05/28/2024

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Directions to “BLOOM BEHAVIOR SERVICES LLC ” Practice Location

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