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General NPI Number Information
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NPI Number | 1184800849
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Entity Type | Organization
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Legal Business Name | BLOOMGARDEN & ASSOCIATES
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Dates
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Enumeration Date | 01/12/2008
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Last Update Date | 08/30/2024
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Provider Practice Location Address
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Address Line | 230 SOUTH BROAD STREET SUITE 1305
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City | PHILADELPHIA
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State | PA
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Zip | 19102
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Country | US
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Telephone | 215-545-1175
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Fax | 215-592-4190
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Provider Business Mailing Address
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Address Line | 230 SOUTH BROAD STREET SUITE 1305
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City | PHILADELPHIA
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State | PA
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Zip | 19102
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Country | US
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Telephone | 215-545-1175
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Fax | 215-592-4190
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Authorized Official
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Title or Position | OWNER
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Name | ANDREA BLOOMGARDEN
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Credential | PH.D.
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Telephone | 215-280-9649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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