Organization
PATHWAYS IN BLOOM PSYCHOLOGICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIELLA MARIE VASQUEZ PSY.D. (OWNER/LICENSED CLINICAL PSYCHOLOGIS)
(813) 436-3588
Entity
Organization
Contact information
Practice address
625 COMMERCE DRIVE, SUITE 104, LAKELAND, FL 33813
(702) 326-6959
Mailing address
13194 US HIGHWAY 301 S # 272, RIVERVIEW, FL 33578-7410
(702) 326-6959
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
11/22/2021
Last updated
04/12/2024
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