Healthcare Provider Details

I. General information

NPI: 1932054723
Provider Name (Legal Business Name): SIMONE BLOOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 02/27/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 WINTERSON RD STE 160
LINTHICUM MD
21090-2245
US

IV. Provider business mailing address

1190 WINTERSON RD STE 160
LINTHICUM MD
21090-2245
US

V. Phone/Fax

Practice location:
  • Phone: 410-684-3806
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR239399
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: