Provider Demographics
NPI:1871344234
Name:BLOMSTRANN, ROBERT (MS, BCBA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BLOMSTRANN
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 HILLS ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-6306
Mailing Address - Country:US
Mailing Address - Phone:860-597-5405
Mailing Address - Fax:
Practice Address - Street 1:550 HARTFORD TPKE
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-5017
Practice Address - Country:US
Practice Address - Phone:860-870-5997
Practice Address - Fax:860-870-8170
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst