Provider Demographics
NPI:1619730330
Name:MINDS IN BLOOM ABA
Entity Type:Organization
Organization Name:MINDS IN BLOOM ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BCBA
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:410-299-6499
Mailing Address - Street 1:34743 STARBOARD CT
Mailing Address - Street 2:
Mailing Address - City:DAGSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19939-3338
Mailing Address - Country:US
Mailing Address - Phone:410-299-6499
Mailing Address - Fax:
Practice Address - Street 1:34743 STARBOARD CT
Practice Address - Street 2:
Practice Address - City:DAGSBORO
Practice Address - State:DE
Practice Address - Zip Code:19939-3338
Practice Address - Country:US
Practice Address - Phone:410-299-6499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty