Healthcare Provider Details

I. General information

NPI: 1922461755
Provider Name (Legal Business Name): ANNA J BLOOMER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N CLAYTON ST MSB SUITE 200
WILMINGTON DE
19805-3165
US

IV. Provider business mailing address

701 N CLAYTON ST MSB SUITE 200
WILMINGTON DE
19805-3165
US

V. Phone/Fax

Practice location:
  • Phone: 302-575-8040
  • Fax: 302-575-8005
Mailing address:
  • Phone: 302-575-8040
  • Fax: 302-575-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0001427
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: