Brain Bloom Neurotherapy Center

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

BRAIN BLOOM NEUROTHERAPY CENTER

Practice address

1303 Vincent PL
MC Lean, VA 22101-3615

Phone

(703) 821-1073

NPI assigned

Jun 12, 2024

Last updated

Jun 12, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lauren Colletti

Title

Office Administrator

Phone

(703) 821-1073

Specialties & licenses 1

Addresses

Locations

Practitioners 7

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.

• Zviadi Aburjania, MD

  • Psychiatry Physician
  • McLean, VA
  • NPI 1811457245
  NPD
• Felicia Renee Dillard, MD

  • Psychiatry Physician
  • McLean, VA
  • NPI 1538746276
  NPD
• Ehsan Habibpour, MD

  • Psychiatry Physician
  • McLean, VA
  • NPI 1396942603
  NPD
• Mary June C So

  • Psychiatric/Mental Health Nurse Practitioner
  • Falls Church, VA
  • NPI 1609258946
  NPD
• Carolyn Heier Young, PSY.D.

  • Clinical Psychologist
  • Reston, VA
  • NPI 1053467084
  NPD (past)
• Sarah McCarthy, APN

  • Family Nurse Practitioner
  • Vista, CA
  • NPI 1063958700
  NPD (past)
• Katherine M Miller-Darras, LCSW

  • Clinical Social Worker
  • Bronx, NY
  • NPI 1831498898
  NPD (past)

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

{
    "created_epoch": "1718150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718150400000",
    "number": "1659113322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1307 VINCENT PL",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221013680",
            "telephone_number": "703-821-1073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1303 VINCENT PL",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221013615",
            "telephone_number": "703-821-1073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAIN BLOOM NEUROTHERAPY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-12",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A",
        "authorized_official_last_name": "COLLETTI",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "703-821-1073"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Judge Bowie, FNP-BC
• Emily Caroline Boyd, MA
• Michelle L. Brachten, LCSW
• Bradley D Wiltbank DMD PC (Dolley Madison Dentistry)
• Susan Summerill Brady, MPT
• Sarah Kay Brandel, PH.D.
• Robin Christine Brannigan, M.D.
• Jacob Andrew Branum
• Mary Lenora Brasher, MS, OTR/L
• Jodi Eileen Brayton, MSW LICSW LCSW

• Mental Health Clinic/Center (Including Community Mental Health Center) in McLean, VA
• Providers in McLean, VA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; 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.