Healthcare Provider Details

I. General information

NPI: 1114833084
Provider Name (Legal Business Name): BLOOM THEORY BEHAVIORAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 AVALON DR UNIT 1234
MILFORD CT
06460-8563
US

IV. Provider business mailing address

10 AVALON DR UNIT 3122
MILFORD CT
06460-8573
US

V. Phone/Fax

Practice location:
  • Phone: 203-675-3602
  • Fax:
Mailing address:
  • Phone: 203-675-3602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ALONA N SCOTT
Title or Position: MANAGING MEMBER
Credential: LCSW
Phone: 475-449-7021