Provider Demographics
NPI:1104662378
Name:INBLOOM AUTISM SERVICES
Entity type:Organization
Organization Name:INBLOOM AUTISM SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGREGOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-717-0484
Mailing Address - Street 1:1750 LOCKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-8735
Mailing Address - Country:US
Mailing Address - Phone:407-717-0484
Mailing Address - Fax:
Practice Address - Street 1:1000 COLOR PL
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-7717
Practice Address - Country:US
Practice Address - Phone:8
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:8
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-06
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty