Provider Demographics
NPI:1316587470
Name:BLOOM THERAPY LLC
Entity Type:Organization
Organization Name:BLOOM THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LACHANCE-POIRRIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-797-6615
Mailing Address - Street 1:142 BODINE RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-1027
Mailing Address - Country:US
Mailing Address - Phone:908-797-6615
Mailing Address - Fax:
Practice Address - Street 1:142 BODINE RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-1027
Practice Address - Country:US
Practice Address - Phone:610-639-4158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty