Healthcare Provider Details

I. General information

NPI: 1326954389
Provider Name (Legal Business Name): BLOOM MENTAL HEALTH COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

108 S FRANKLIN AVE STE 3
VALLEY STREAM NY
11580-6105
US

IV. Provider business mailing address

365 CLINTON AVE APT 1B
BROOKLYN NY
11238-1151
US

V. Phone/Fax

Practice location:
  • Phone: 347-731-4734
  • Fax: 516-303-9925
Mailing address:
  • Phone: 347-731-4734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBORAH MICHELLE DEJEAN
Title or Position: CLINICAL DIRECTOR
Credential: LMHC
Phone: 347-731-4734