Blue Balloon Indian Creek LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

BLUE BALLOON INDIAN CREEK LLC

Practice address

12240 Indian Creek CT Ste 100
Beltsville, MD 20705-1242

Phone

(201) 216-9500

NPI assigned

Apr 2, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Mariam Newmark, M.ED, BCBA, LBA

Title

Clinical Director

Phone

(201) 216-9500

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1712016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712016000000",
    "number": "1073365243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 BELGROVE DR",
            "city": "KEARNY",
            "state": "NJ",
            "postal_code": "070321507",
            "telephone_number": "201-216-9500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12240 INDIAN CREEK CT STE 100",
            "city": "BELTSVILLE",
            "state": "MD",
            "postal_code": "207051242",
            "telephone_number": "201-216-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE BALLOON INDIAN CREEK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-02",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A",
        "authorized_official_last_name": "NEWMARK",
        "authorized_official_first_name": "MARIAM",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "201-216-9500",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.ED, BCBA, LBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in Beltsville, MD
• Providers in Beltsville, MD by specialty
• Behavior Analyst in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.