MEDICARE: BLOOMING HEARTS BEHAVIORAL HEALTH AND CHILD DEVELOPMENT

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	:	1952265019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOMING HEARTS BEHAVIORAL HEALTH AND CHILD DEVELOPMENT

Provider Business Mailing Address
First Line	:	7741 SURREYWOOD PL
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-2158
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7741 SURREYWOOD PL
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-2158
Country	:	US
Telephone Number	:	786-606-8011
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JESSICA ANDINO
Credential	:	BCBA, LBA
Telephone Number	:	786-606-8011

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	12/12/2025

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Directions to “BLOOMING HEARTS BEHAVIORAL HEALTH AND CHILD DEVELOPMENT ” Practice Location

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