Healthcare Provider Details

I. General information

NPI: 1679384739
Provider Name (Legal Business Name): BLOOM BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PASSAIC AVE STE 200
FAIRFIELD NJ
07004-2518
US

IV. Provider business mailing address

250 PASSAIC AVE STE 200
FAIRFIELD NJ
07004-2518
US

V. Phone/Fax

Practice location:
  • Phone: 973-784-8837
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE BURNEY
Title or Position: OWNER
Credential:
Phone: 973-510-5578