Individual
LORRAINE BLOOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA, LBA
Contact information
Practice address
67 RIVERVIEW AVE, PORTSMOUTH, VA 23704-1928
(313) 675-0411
(866) 586-0747
Mailing address
67 RIVERVIEW AVE, PORTSMOUTH, VA 23704-1928
(313) 675-0411
(866) 586-0747
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0133000240
VA
Other
Enumeration date
08/22/2013
Last updated
01/05/2016
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