Provider Demographics
NPI:1003191321
Name:TORUS BLOOM, LLC
Entity Type:Organization
Organization Name:TORUS BLOOM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DAUNE
Authorized Official - Middle Name:ALEXANDRIA
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-266-6238
Mailing Address - Street 1:100 WELLS ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06103-2928
Mailing Address - Country:US
Mailing Address - Phone:860-266-6238
Mailing Address - Fax:
Practice Address - Street 1:100 WELLS ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103-2928
Practice Address - Country:US
Practice Address - Phone:860-266-6238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001181101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty