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General NPI Number Information
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NPI Number | 1649154030
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Entity Type | Organization
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Legal Business Name | BLOOM WELLNESS CENTER
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Dates
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Enumeration Date | 07/31/2025
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Last Update Date | 11/28/2025
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Provider Practice Location Address
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Address Line | 4 CORPORATE DR STE 490
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City | SHELTON
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State | CT
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Zip | 06484-6263
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Country | US
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Telephone | 203-780-1561
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Fax |
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Provider Business Mailing Address
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Address Line | 4 CORPORATE DR STE 490
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City | SHELTON
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State | CT
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Zip | 06484-6263
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Country | US
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Telephone | 203-780-1561
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | AMANDA ROCCATOVIEIRAFRANCO PALACIO
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Credential | LCSW
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Telephone | 203-780-1561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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