Provider Demographics
NPI:1649841651
Name:BLOOME, INC
Entity type:Organization
Organization Name:BLOOME, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOMOF
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, PSYD
Authorized Official - Phone:818-434-3679
Mailing Address - Street 1:5900 SEPULVEDA BLVD STE 102-1
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5900 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91411-2511
Practice Address - Country:US
Practice Address - Phone:818-434-3679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-09
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health