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General NPI Number Information
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NPI Number | 1548270994
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Entity Type | Individual
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Provider Name | SERENA LURIE BLOOMFIELD ED.D.
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Gender | Female
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 3725 DUPONT STATION CT S SUITE 3
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2518
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Country | US
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Telephone | 904-448-1519
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Fax | 904-733-1340
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Provider Business Mailing Address
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Address Line | 3725 DUPONT STATION CT S SUITE 3
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2518
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Country | US
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Telephone | 904-448-1519
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Fax | 904-733-1340
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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 | PY0004692
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License Number State | FL
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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 | 3957
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PY0004692
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | PY0004692
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License Number State | FL
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