Provider Demographics
NPI:1114812542
Name:BRIDGE AND BLOOM THERAPY
Entity type:Organization
Organization Name:BRIDGE AND BLOOM THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:805-428-7260
Mailing Address - Street 1:1619 W 19TH ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-2901
Mailing Address - Country:US
Mailing Address - Phone:805-428-7260
Mailing Address - Fax:
Practice Address - Street 1:1619 W 19TH ST APT 1F
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-2901
Practice Address - Country:US
Practice Address - Phone:805-428-7260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-09
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health