Provider Demographics
NPI:1952131856
Name:IBLOOM THERAPY INC.,
Entity type:Organization
Organization Name:IBLOOM THERAPY INC.,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARERI
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:760-521-6113
Mailing Address - Street 1:4140 OCEANSIDE BLVD STE 159 PMB 2002
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-6005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3699 BARNARD DR APT 521
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4003
Practice Address - Country:US
Practice Address - Phone:760-521-6113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty