Provider Demographics
NPI:1023790334
Name:BLOSSOMING SKIES LEARNING CONSULTANTS, LLC.
Entity type:Organization
Organization Name:BLOSSOMING SKIES LEARNING CONSULTANTS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/ BEHAVIOR ANALYST
Authorized Official - Prefix:MS
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:845-893-0066
Mailing Address - Street 1:46 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07033-1547
Mailing Address - Country:US
Mailing Address - Phone:908-247-7858
Mailing Address - Fax:
Practice Address - Street 1:46 N 10TH ST
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07033-1547
Practice Address - Country:US
Practice Address - Phone:908-247-7858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty