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General NPI Number Information
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NPI Number | 1487948972
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Entity Type | Individual
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Provider Name | AUDREY BLOOM LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/02/2011
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Last Update Date | 06/02/2011
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Provider Practice Location Address
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Address Line | 2000 S DIXIE HWY SUITE 104, COCONUT GROVE CENTER
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City | MIAMI
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State | FL
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Zip | 33133-2456
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Country | US
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Telephone | 305-301-8251
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Fax |
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Provider Business Mailing Address
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Address Line | 17142 SW 112TH CT
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City | MIAMI
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State | FL
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Zip | 33157-3907
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Country | US
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Telephone | 305-301-8251
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 10388
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License Number State | FL
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