Healthcare Provider Details

I. General information

NPI: 1104741719
Provider Name (Legal Business Name): LAUREN BLOOMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CUMMINGS CTR STE 535N
BEVERLY MA
01915-6231
US

IV. Provider business mailing address

100 WASHINGTON ST APT 44
SALEM MA
01970-3525
US

V. Phone/Fax

Practice location:
  • Phone: 978-854-2185
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: