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General NPI Number Information
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NPI Number | 1780825661
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Entity Type | Organization
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Legal Business Name | THE COMMUNITY, LLC
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Dates
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Enumeration Date | 03/23/2009
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Last Update Date | 03/23/2009
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Provider Practice Location Address
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Address Line | 16 NE 4TH ST SUITE 130
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-3262
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Country | US
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Telephone | 954-533-9818
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Fax | 954-533-9819
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Provider Business Mailing Address
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Address Line | 16 NE 4TH ST SUITE 130
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-3262
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Country | US
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Telephone | 954-533-9818
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Fax | 954-533-9819
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. JUDITH LEE BLOOM
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Credential | LMFT, MSW
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Telephone | 954-533-9818
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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 | MT 2236
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License Number State | FL
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