Healthcare Provider Details

I. General information

NPI: 1982392650
Provider Name (Legal Business Name): CRISTINA B BLOOM MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 05/01/2023
Certification Date: 04/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 S ALLEN ST STE 303
STATE COLLEGE PA
16801-5946
US

IV. Provider business mailing address

1315 S ALLEN ST STE 303
STATE COLLEGE PA
16801-5946
US

V. Phone/Fax

Practice location:
  • Phone: 814-571-3136
  • Fax:
Mailing address:
  • Phone: 917-224-2138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW135982
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: