=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487473864
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLOOMING HARMONY THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2024
-----------------------------------------------------
Last Update Date | 10/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 N MACLAY AVE UNIT D211
-----------------------------------------------------
City | SAN FERNANDO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91340-2940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-617-5098
-----------------------------------------------------
Fax | 903-617-5098
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10606 TAMARACK AVE
-----------------------------------------------------
City | PACOIMA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91331-3045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-617-5098
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | VIRGINIA CECIBEL ORANTES
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 818-869-0282
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------