MEDICARE: BLOOM BEHAVIORAL CONNECTIONS 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

General Provider Information

NPI Number	:	1902538333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOM BEHAVIORAL CONNECTIONS LLC

Provider Business Mailing Address
First Line	:	312 S CHADWICK ST # 2R
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6706
Country	:	US
Telephone Number	:	732-453-4772
Fax Number	:	213-603-4381

Provider Business Practice Location Address
First Line	:	312 S CHADWICK ST # 2R
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6706
Country	:	US
Telephone Number	:	267-467-6599
Fax Number	:	213-603-4381

Authorized Official
Title or Position	:	OWNER
Name	:	DANA SULLIVAN
Credential	:	BCBA
Telephone Number	:	732-453-4772

Provider Enumeration Date	:	06/24/2022
Last Update Date	:	03/23/2026

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