# BLOSSUM DEVELOPMENTAL SOLUTIONS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003613241
- **Authorized official:** MR. JAMAL S STEPHENS (CEO)
- **Authorized official phone:** (856) 383-6253

## Contact information

- **Practice address:** 5016 BERGENLINE AVE UNIT 2, WEST NEW YORK, NJ 07093-5522
- **Practice address phone:** (856) 383-6253
- **Mailing address:** 5016 BERGENLINE AVE UNIT 2, WEST NEW YORK, NJ 07093-5522
- **Mailing address phone:** (856) 383-6253

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106S00000X | Behavior Technician | — | NULL | — |
| 106S00000X | Behavior Technician | — | — | — |
| 171M00000X | Case Manager/Care Coordinator | — | NULL | Yes |
| 171M00000X | Case Manager/Care Coordinator | — | — | Yes |

## Other

- **Enumeration date:** 02/26/2025
- **Last updated:** 02/26/2025