Healthcare Provider Details

I. General information

NPI: 1245140201
Provider Name (Legal Business Name): BLOOM PEER SUPPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 E EVERGREEN RD
NEW CITY NY
10956-5145
US

IV. Provider business mailing address

3 E EVERGREEN RD UNIT 101 PMB 111
NEW CITY NY
10956-5146
US

V. Phone/Fax

Practice location:
  • Phone: 845-213-3134
  • 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 StateNULL

VIII. Authorized Official

Name: JOSEPH MOWSHOWITZ
Title or Position: CEO
Credential:
Phone: 845-213-3134