Provider Demographics
NPI:1740947902
Name:BLOOMING WELLNESS & THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:BLOOMING WELLNESS & THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:
Authorized Official - First Name:ROSELIND
Authorized Official - Middle Name:VELEZ
Authorized Official - Last Name:AMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:203-314-9715
Mailing Address - Street 1:234R DUNCASTER RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-1110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:234R DUNCASTER RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-1110
Practice Address - Country:US
Practice Address - Phone:860-431-0968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1780257865Medicaid