Provider Demographics
NPI:1528826500
Name:BLUE BLOCKS LLC
Entity type:Organization
Organization Name:BLUE BLOCKS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMARK
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA, LBA
Authorized Official - Phone:201-216-9500
Mailing Address - Street 1:12240 INDIAN CREEK CT STE 100
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-1242
Mailing Address - Country:US
Mailing Address - Phone:201-216-9500
Mailing Address - Fax:
Practice Address - Street 1:12240 INDIAN CREEK CT STE 100
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-1242
Practice Address - Country:US
Practice Address - Phone:201-216-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUE BALLOON MD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-13
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty