| NPI | 1871482414 |
|---|---|
| Doing Business As | BLOOM |
| Doing Business As | BLOSSOM |
| Entity Type | Organization |
| Authorized Contact | SUSAN CAPRICE JACKSON CEO 917-400-5108 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-06-30 |
| Last Update Date | 2025-06-30 |