Provider Demographics
NPI:1336548320
Name:ROOM TO BLOOM THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:ROOM TO BLOOM THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOLLACO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-255-0305
Mailing Address - Street 1:44 BRIMLEY MNR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-4456
Mailing Address - Country:US
Mailing Address - Phone:585-255-0305
Mailing Address - Fax:
Practice Address - Street 1:44 BRIMLEY MNR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612
Practice Address - Country:US
Practice Address - Phone:585-255-0305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-15
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management