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General NPI Number Information
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NPI Number | 1669177077
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Entity Type | Organization
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Legal Business Name | BLOSSOMING ROOTS THERAPY LLC
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Dates
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Enumeration Date | 04/04/2023
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Last Update Date | 04/04/2023
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Provider Practice Location Address
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Address Line | 159 MAIN ST STE L
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City | AGAWAM
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State | MA
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Zip | 01001-1854
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Country | US
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Telephone | 413-437-0419
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Fax |
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Provider Business Mailing Address
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Address Line | 159 MAIN ST STE L
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City | AGAWAM
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State | MA
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Zip | 01001-1854
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Country | US
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Telephone | 413-437-0419
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Fax |
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Authorized Official
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Title or Position | LMFT
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Name | EMELY CHENARD
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Credential |
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Telephone | 203-361-4054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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