Provider Demographics
NPI:1417789777
Name:VALLEY BLOOM THERAPY GROUP
Entity type:Organization
Organization Name:VALLEY BLOOM THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIANA
Authorized Official - Middle Name:PABON
Authorized Official - Last Name:CARRUS
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP, BCBA, COBA
Authorized Official - Phone:216-308-1698
Mailing Address - Street 1:7100 E PLEASANT VALLEY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-5545
Mailing Address - Country:US
Mailing Address - Phone:216-308-1698
Mailing Address - Fax:216-264-8090
Practice Address - Street 1:7100 E PLEASANT VALLEY RD STE 100
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-5545
Practice Address - Country:US
Practice Address - Phone:216-202-4042
Practice Address - Fax:216-264-8090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-15
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst