MEDICARE: BLOOM TO VITALITY THERAPY, 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	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1831079839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOM TO VITALITY THERAPY, LLC

Provider Business Mailing Address
First Line	:	1961 SHENANGO VALLEY FWY LOWR LEVEL
Second Line	:
City	:	HERMITAGE
State	:	PA
Zip	:	16148-2501
Country	:	US
Telephone Number	:	724-300-3521
Fax Number	:

Provider Business Practice Location Address
First Line	:	1961 SHENANGO VALLEY FWY LOWR LEVEL
Second Line	:
City	:	HERMITAGE
State	:	PA
Zip	:	16148-2501
Country	:	US
Telephone Number	:	724-300-3521
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHELLE LOMBARDO
Credential	:	LCSW
Telephone Number	:	724-300-3521

Provider Enumeration Date	:	09/03/2025
Last Update Date	:	01/21/2026

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Directions to “BLOOM TO VITALITY THERAPY, LLC ” Practice Location

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