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General NPI Number Information
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NPI Number | 1396272993
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Entity Type | Organization
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Legal Business Name | BLOOM PSYCHOTHERAPY NYC LCSW PC
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Dates
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Enumeration Date | 05/15/2017
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Last Update Date | 05/15/2017
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Provider Practice Location Address
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Address Line | 19 W 34TH ST PH
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City | NEW YORK
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State | NY
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Zip | 10001-3006
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Country | US
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Telephone | 917-830-6035
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Fax |
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Provider Business Mailing Address
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Address Line | 125 OCEAN AVE APT 5H
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City | BROOKLYN
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State | NY
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Zip | 11225-4724
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Country | US
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Telephone | 917-626-3847
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER/ PRESIDENT
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Name | ANUPAMA KALYANAM
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Credential | LCSW
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Telephone | 917-830-6035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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