Individual
MR. STANLEY SHANE BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
98-939 MOANALUA RD, AIEA, HI 96701-5012
(855) 223-7123
Mailing address
PO BOX 33568, SAN DIEGO, CA 92163-3568
(855) 223-7123
(619) 374-7134
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
1-20-42966
HI
103K00000X
Behavior Analyst
Primary
BA-433
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BA-433-0
LICENSED BEHAVIOR ANALYST
HI
Enumeration date
06/07/2017
Last updated
10/02/2024
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