Healthcare Provider Details

I. General information

NPI: 1992094692
Provider Name (Legal Business Name): SHARONNA BLOOM LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 1ST AVE
NEW YORK NY
10029-7404
US

IV. Provider business mailing address

37 OVERLOOK TER APT 3D
NEW YORK NY
10033-2211
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-6262
  • Fax:
Mailing address:
  • Phone: 201-230-4138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number078042
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: