Healthcare Provider Details

I. General information

NPI: 1831052927
Provider Name (Legal Business Name): BLOOMING INTEGRATIVE PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 BRIDGE ST
WEST ENFIELD ME
04493-4518
US

IV. Provider business mailing address

41 BRIDGE ST
WEST ENFIELD ME
04493-4518
US

V. Phone/Fax

Practice location:
  • Phone: 207-447-7837
  • Fax: 207-358-2577
Mailing address:
  • Phone: 207-447-7837
  • Fax: 207-358-2577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. ILEANA IRINA VINTILA
Title or Position: ADVANCED PRACTICE REGISTERED NURSE
Credential: PMHNP-BC
Phone: 207-447-7837