Organization
BLOOM PSYCH SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANANTHAKUMAR THILLAINATHAN MD (OWNER)
(203) 683-0625
Entity
Organization
Contact information
Practice address
3000 MAIN ST, STRATFORD, CT 06614-4939
(203) 683-0625
Mailing address
3000 MAIN ST, STRATFORD, CT 06614-4939
(203) 683-0625
Taxonomy
Speciality
Code
Description
License number
State
103TP2701X
Group Psychotherapy Psychologist
—
—
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
Primary
—
—
Other
Enumeration date
07/19/2021
Last updated
08/17/2021
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