Provider Demographics
NPI:1649154030
Name:BLOOM WELLNESS CENTER
Entity type:Organization
Organization Name:BLOOM WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:ROCCATOVIEIRAFRANCO
Authorized Official - Last Name:PALACIO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-529-7024
Mailing Address - Street 1:20 TWAROG PL
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-2940
Mailing Address - Country:US
Mailing Address - Phone:203-529-7024
Mailing Address - Fax:
Practice Address - Street 1:20 TWAROG PL
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-2940
Practice Address - Country:US
Practice Address - Phone:203-529-7024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)