Provider Demographics
NPI:1669177077
Name:BLOSSOMING ROOTS THERAPY LLC
Entity type:Organization
Organization Name:BLOSSOMING ROOTS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:
Authorized Official - First Name:EMELY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHENARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-361-4054
Mailing Address - Street 1:159 MAIN ST STE L
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-1854
Mailing Address - Country:US
Mailing Address - Phone:413-437-0419
Mailing Address - Fax:
Practice Address - Street 1:159 MAIN ST STE L
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-1854
Practice Address - Country:US
Practice Address - Phone:413-437-0419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty