Provider Demographics
NPI:1851042766
Name:BLOOM MENTAL HEALTH FOUNDATION
Entity Type:Organization
Organization Name:BLOOM MENTAL HEALTH FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLI
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPAS-PASCO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-912-2367
Mailing Address - Street 1:1303 MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3021
Mailing Address - Country:US
Mailing Address - Phone:757-912-2367
Mailing Address - Fax:757-578-9119
Practice Address - Street 1:1303 MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3021
Practice Address - Country:US
Practice Address - Phone:757-912-2367
Practice Address - Fax:757-578-9119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty