Provider Demographics
NPI:1083505887
Name:LAVENDER BLOOM MENTAL HEALTH SERVICES
Entity type:Organization
Organization Name:LAVENDER BLOOM MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DIA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-419-9399
Mailing Address - Street 1:185 PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-5536
Mailing Address - Country:US
Mailing Address - Phone:860-419-9399
Mailing Address - Fax:585-361-6947
Practice Address - Street 1:185 PATTERSON ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-5536
Practice Address - Country:US
Practice Address - Phone:860-419-9399
Practice Address - Fax:585-361-6947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health