Provider Demographics
NPI:1467158055
Name:NURTURE TO BLOOM
Entity type:Organization
Organization Name:NURTURE TO BLOOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:ANDERSON-TRIM
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:862-205-1234
Mailing Address - Street 1:62 STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-1709
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:147 CENTRAL ST STE 200
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1960
Practice Address - Country:US
Practice Address - Phone:978-487-5887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty