Organization
BLOSSOM MINDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA CORUJO FEIJOO BCBA (CLINICAL DIRECTOR)
(954) 512-4827
Entity
Organization
Contact information
Practice address
2645 EXECUTIVE PARK DR STE 534, WESTON, FL 33331-3624
(954) 512-4827
Mailing address
2645 EXECUTIVE PARK DR STE 534, WESTON, FL 33331-3624
(954) 512-4827
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164975355
—
FL
Enumeration date
09/26/2022
Last updated
09/26/2022
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