Healthcare Provider Details

I. General information

NPI: 1891212833
Provider Name (Legal Business Name): MATTHEW F. BLOOM PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 7TH ST
ROBINS AFB GA
31098-2227
US

IV. Provider business mailing address

655 7TH ST
ROBINS AFB GA
31098-2227
US

V. Phone/Fax

Practice location:
  • Phone: 478-327-7850
  • Fax:
Mailing address:
  • Phone: 478-327-7850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number9282
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC009283
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810008601
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: