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General NPI Number Information
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NPI Number | 1487678207
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Entity Type | Individual
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Provider Name | RICHARD BLOOM MFT
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Gender | Male
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 865 3RD ST
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City | SANTA ROSA
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State | CA
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Zip | 95404-4515
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Country | US
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Telephone | 707-665-0846
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Fax |
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Provider Business Mailing Address
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Address Line | 755 W SIERRA AVE
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City | COTATI
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State | CA
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Zip | 94931-4281
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Country | US
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Telephone |
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC19312
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License Number State | CA
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