Provider Demographics
NPI:1447065453
Name:BLOOM PSYCHIATRY
Entity type:Organization
Organization Name:BLOOM PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST/PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REILLY-PRADO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-890-9636
Mailing Address - Street 1:790 E MARKET ST STE 355
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-5804
Mailing Address - Country:US
Mailing Address - Phone:610-890-9636
Mailing Address - Fax:
Practice Address - Street 1:790 E MARKET ST STE 355
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-5804
Practice Address - Country:US
Practice Address - Phone:610-890-9636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-08
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty