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General NPI Number Information
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NPI Number | 1376282558
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Entity Type | Organization
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Legal Business Name | BLOOM TOWN LLC
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Dates
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Enumeration Date | 06/03/2022
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 491 BALTIMORE PIKE STE 1213
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City | SPRINGFIELD
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State | PA
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Zip | 19064-3810
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Country | US
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Telephone | 267-816-5357
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Fax |
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Provider Business Mailing Address
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Address Line | 491 BALTIMORE PIKE STE 1213
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City | SPRINGFIELD
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State | PA
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Zip | 19064-3810
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Country | US
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Telephone | 267-816-5357
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Fax |
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Authorized Official
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Title or Position | CLINICIAN
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Name | AQUILLA ALI
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Credential |
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Telephone | 267-816-5357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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