Healthcare Provider Details

I. General information

NPI: 1932087145
Provider Name (Legal Business Name): BLOOM BEHAVIORAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9930 NW 21ST ST STE 202
DORAL FL
33172-2212
US

IV. Provider business mailing address

9930 NW 21ST ST STE 202
DORAL FL
33172-2212
US

V. Phone/Fax

Practice location:
  • Phone: 305-318-9898
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: YENISEI FERIA
Title or Position: PRESIDENT
Credential:
Phone: 305-318-9898