Provider Demographics
NPI:1447141189
Name:NEUROBLOOM MENTAL HEALTH COLLECTIVE, LLC
Entity type:Organization
Organization Name:NEUROBLOOM MENTAL HEALTH COLLECTIVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AZZAH
Authorized Official - Middle Name:NAJMADDIN
Authorized Official - Last Name:NASRADDIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MPH
Authorized Official - Phone:319-325-4493
Mailing Address - Street 1:838 W SUNNYSIDE AVE APT 3W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-6129
Mailing Address - Country:US
Mailing Address - Phone:319-325-4493
Mailing Address - Fax:
Practice Address - Street 1:838 W SUNNYSIDE AVE APT 3W
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-6129
Practice Address - Country:US
Practice Address - Phone:319-325-4493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty