Organization
BEHAVIOR BLOOM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMANTHA MINERD BCBA (OWNER, BCBA)
(440) 821-8375
Entity
Organization
Contact information
Practice address
680 JANE STANFORD WAY # C184, STANFORD, CA 94305-7313
(440) 821-8375
Mailing address
2158 WILLIAMS ST, PALO ALTO, CA 94306-1416
(440) 821-8375
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1659875367
APPLIED BEHAVIOR ANALYSIS
CA
Enumeration date
01/06/2022
Last updated
07/15/2022
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