MEDICARE: NU BLOOM COUNSELING

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	106H00000X	Marriage & Family Therapist
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1518590736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NU BLOOM COUNSELING

Provider Business Mailing Address
First Line	:	1 LEA LN
Second Line	:
City	:	NEW MILFORD
State	:	CT
Zip	:	06776-3064
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 MEADOW ST UNIT 1
Second Line	:
City	:	LITCHFIELD
State	:	CT
Zip	:	06759-3504
Country	:	US
Telephone Number	:	860-717-2833
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KIMBERLEY WORTHINGTON
Credential	:	LCSW
Telephone Number	:	860-717-2833

Provider Enumeration Date	:	02/17/2020
Last Update Date	:	02/17/2020

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Directions to “NU BLOOM COUNSELING ” Practice Location

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