Organization
BLOOM WELLNESS LLC
Active
Other names
Mind Body Family
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDRA MARIN LCSW (FOUNDER/OWNER)
(310) 384-3322
Entity
Organization
Contact information
Practice address
2132 W ROSCOE ST, CHICAGO, IL 60618-6241
(310) 384-3322
Mailing address
2132 W ROSCOE ST, CHICAGO, IL 60618-6241
(310) 384-3322
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1750707394
NPI
—
Enumeration date
10/04/2022
Last updated
10/04/2022
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