Healthcare Provider Details

I. General information

NPI: 1740523240
Provider Name (Legal Business Name): HILDA HANNAH BLOOMBERG,LICSW,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 GLEANER CHAPEL RD
N SCITUATE RI
02857-1204
US

IV. Provider business mailing address

117 GLEANER CHAPEL RD
N SCITUATE RI
02857-1204
US

V. Phone/Fax

Practice location:
  • Phone: 401-369-1916
  • Fax: 401-647-7719
Mailing address:
  • Phone: 401-369-1916
  • Fax: 401-647-7719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberISW01403
License Number StateRI

VIII. Authorized Official

Name: MS. HILDA HANNAH BLOOMBERG
Title or Position: AUTHORIZED OFFICIAL
Credential: MSW, LICSW
Phone: 401-369-1916