MEDICARE: TORUS BLOOM, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	001181	CT

General Provider Information

NPI Number	:	1003191321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TORUS BLOOM, LLC

Provider Business Mailing Address
First Line	:	100 WELLS ST
Second Line	:	SUITE 1A
City	:	HARTFORD
State	:	CT
Zip	:	06103-2928
Country	:	US
Telephone Number	:	860-266-6238
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 WELLS ST
Second Line	:	SUITE 1A
City	:	HARTFORD
State	:	CT
Zip	:	06103-2928
Country	:	US
Telephone Number	:	860-266-6238
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. DAUNE ALEXANDRIA KEMP
Credential	:	LPC
Telephone Number	:	860-266-6238

Provider Enumeration Date	:	10/18/2011
Last Update Date	:	10/18/2011

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