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General NPI Number Information
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NPI Number | 1316983380
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Entity Type | Individual
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Provider Name | ANDREA L BLOOMGARDEN PH D
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Gender | Female
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 230 S BROAD ST STE 1305
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City | PHILADELPHIA
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State | PA
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Zip | 19102-4104
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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 | 709 S MILDRED ST
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City | PHILADELPHIA
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State | PA
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Zip | 19147-2041
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 012038 1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | B10000498
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License Number State | DE
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS 006943 L
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License Number State | PA
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