Provider Demographics
NPI:1861930679
Name:BLOSSOM BEHAVIOR CONSULTANTS
Entity type:Organization
Organization Name:BLOSSOM BEHAVIOR CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:MEERBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-331-2266
Mailing Address - Street 1:20 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-4383
Mailing Address - Country:US
Mailing Address - Phone:617-331-2266
Mailing Address - Fax:
Practice Address - Street 1:20 STRAWBERRY LN
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:MA
Practice Address - Zip Code:02790-4383
Practice Address - Country:US
Practice Address - Phone:617-331-2266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0000001312251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health