Provider Demographics
NPI:1588933907
Name:WESTON-BLOOM, MICHELLE (MSED, BCBA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:WESTON-BLOOM
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SYCAMORE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-8641
Mailing Address - Country:US
Mailing Address - Phone:516-404-0838
Mailing Address - Fax:631-849-5731
Practice Address - Street 1:22 SYCAMORE RD
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-8641
Practice Address - Country:US
Practice Address - Phone:516-404-0838
Practice Address - Fax:631-849-5731
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst