Provider Demographics
NPI:1346029535
Name:BLOSSOM & THRIVE THERAPY LLC
Entity Type:Organization
Organization Name:BLOSSOM & THRIVE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:CHARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAYAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:321-209-2005
Mailing Address - Street 1:3425 BAYSIDE LAKES BLVD SE ST 103
Mailing Address - Street 2:PMB 1177
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-6867
Mailing Address - Country:US
Mailing Address - Phone:321-209-2005
Mailing Address - Fax:
Practice Address - Street 1:3425 BAYSIDE LAKES BLVD SE ST 103
Practice Address - Street 2:PMB 1177
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-6867
Practice Address - Country:US
Practice Address - Phone:321-345-9566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty