Organization Name: | TORUS BLOOM, LLC |
NPI Number: | 1003191321 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAUNE ALEXANDRIA KEMP (DIRECTOR) |
Mailing Address: | 100 Wells St Suite 1a Hartford |
State: | CT US |
Postal Code: | 061032928 |
Phone Number: | 8602666238 |
Fax Number: | |
NPI Enumeration Date: | 10/18/2011 |
NPI Last Update Date: | 10/18/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 001181 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |