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General NPI Number Information
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NPI Number | 1760340590
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Entity Type | Organization
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Legal Business Name | BLOOM PSYCHOLOGICAL SERVICES, PLLC
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Dates
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Enumeration Date | 01/12/2026
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 202 MILL RD
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City | EVERETT
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State | MA
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Zip | 02149-3072
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Country | US
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Telephone | 203-770-6147
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Fax |
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Provider Business Mailing Address
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Address Line | 202 MILL RD APT 336
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City | EVERETT
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State | MA
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Zip | 02149-3087
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Country | US
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Telephone | 203-770-6147
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Fax |
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Authorized Official
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Title or Position | OWNER, PSYCHOTHERAPIST
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Name | LUCILLE WHITEHOUSE
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Credential | LADC-I, CADC, LICSW
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Telephone | 203-770-6147
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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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