Healthcare Provider Details

I. General information

NPI: 1508703299
Provider Name (Legal Business Name): BLOOM COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 MAPLE AVE
RED BANK NJ
07701-1764
US

IV. Provider business mailing address

424 HAWTHORNE ST
KEYPORT NJ
07735-5164
US

V. Phone/Fax

Practice location:
  • Phone: 917-922-2707
  • Fax:
Mailing address:
  • Phone: 917-922-2707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: BETH H SOBOL
Title or Position: THERAPIST/OWNER
Credential: LCSW
Phone: 917-922-2707