Provider Demographics
NPI:1487219887
Name:BLOSSOMING BEHAVIOR, APPLIED BEHAVIOR ANALYSTS LLC
Entity Type:Organization
Organization Name:BLOSSOMING BEHAVIOR, APPLIED BEHAVIOR ANALYSTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:AUGUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:516-469-1415
Mailing Address - Street 1:3604 OCEAN AVE APT C2
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-1565
Mailing Address - Country:US
Mailing Address - Phone:516-469-1415
Mailing Address - Fax:
Practice Address - Street 1:61 7TH ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1275
Practice Address - Country:US
Practice Address - Phone:516-469-1415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty