Shadow Bloom Psychological Services PLLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

SHADOW BLOOM PSYCHOLOGICAL SERVICES PLLC

Doing business as

Heathen Health Cole

Practice address

44 Court St Ste 1217
Brooklyn, NY 11201-4410

Phone

(646) 632-2324

NPI assigned

Aug 11, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mariely Hernandez, PHDNPI 1215611280

Title

Member & Clinical Psychologist

Phone

(646) 632-2324

Specialties & licenses 1

Addresses

Other names 1

• Heathen Health Cole Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mariely Hernandez, PH.D

  • Psychologist
  • Brooklyn, NY
  • NPI 1215611280
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1754870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754870400000",
    "number": "1326924986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 COURT ST STE 1217",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112014410",
            "telephone_number": "646-632-2324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 COURT ST STE 1217",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112014410",
            "telephone_number": "646-632-2324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADOW BLOOM PSYCHOLOGICAL SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-11",
        "last_updated": "2025-08-11",
        "certification_date": "2025-08-11",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "MARIELY",
        "authorized_official_title_or_position": "MEMBER & CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "646-632-2324",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heathen Health Cole",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shades of Nostrand Inc.
• Pedram Shadibakhsh, FNP
• Abduraim Shadiev
• Marie-Florence Shadlen, M.D.
• Shadnam Inc (Parker and Megna)
• Richard Shadrin
• Bracha Dinah Shadrouz, OTR/L
• Dorit Shadrouz
• Hadassah Shadrouz, PA-C
• Joseph Shadrouz

• Clinical Psychologist in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.