Healthcare Provider Details

I. General information

NPI: 1902762388
Provider Name (Legal Business Name): BRIDGE & BLOOM THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19306 ECORSE RD STE 103
ALLEN PARK MI
48101-2262
US

IV. Provider business mailing address

19306 ECORSE RD STE 103
ALLEN PARK MI
48101-2262
US

V. Phone/Fax

Practice location:
  • Phone: 734-845-9535
  • Fax:
Mailing address:
  • Phone: 734-845-9535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DIANA SCHEIN
Title or Position: LICENSED MASTER SOCIAL WORKER
Credential: LMSW
Phone: 734-845-9535