Provider Demographics
NPI:1902538333
Name:BLOOM BEHAVIORAL CONNECTIONS LLC
Entity Type:Organization
Organization Name:BLOOM BEHAVIORAL CONNECTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:732-453-4772
Mailing Address - Street 1:1500 CHESTNUT STREET
Mailing Address - Street 2:SUITE 2 #2545
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102
Mailing Address - Country:US
Mailing Address - Phone:732-453-4772
Mailing Address - Fax:
Practice Address - Street 1:1500 CHESTNUT STREET
Practice Address - Street 2:SUITE 2 #2545
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102
Practice Address - Country:US
Practice Address - Phone:267-467-6599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-24
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty