Provider Demographics
NPI:1316835473
Name:NEUROBLOOM ABA LLC
Entity type:Organization
Organization Name:NEUROBLOOM ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BCBA
Authorized Official - Prefix:
Authorized Official - First Name:CESIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNAL
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:606-465-7588
Mailing Address - Street 1:4032 FERGUSON DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-6261
Mailing Address - Country:US
Mailing Address - Phone:606-465-7588
Mailing Address - Fax:
Practice Address - Street 1:4032 FERGUSON DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-6261
Practice Address - Country:US
Practice Address - Phone:606-465-7588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)