Provider Demographics
NPI:1861853921
Name:BLUM, KRISTEN (BCBA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BLUM
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 E 54TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-3219
Mailing Address - Country:US
Mailing Address - Phone:317-584-5166
Mailing Address - Fax:317-815-3861
Practice Address - Street 1:145 ROSEMARY ST
Practice Address - Street 2:SUITE K1
Practice Address - City:NEEDHAM HEIGHTS
Practice Address - State:MA
Practice Address - Zip Code:02494-3238
Practice Address - Country:US
Practice Address - Phone:978-737-3760
Practice Address - Fax:317-815-3861
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst