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General NPI Number Information
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NPI Number | 1871641282
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Entity Type | Individual
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Provider Name | RICHARD KENNETH BLOOM PHD
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Gender | Male
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 03/14/2024
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Provider Practice Location Address
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Address Line | 1369 CROWN DR
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City | ALAMEDA
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State | CA
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Zip | 94501-3727
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Country | US
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Telephone | 510-334-9373
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Fax | 510-724-5304
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Provider Business Mailing Address
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Address Line | 1369 CROWN DR # 11
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City | ALAMEDA
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State | CA
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Zip | 94501-3727
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Country | US
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Telephone | 510-334-9373
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Fax | 510-724-5304
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY8494
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License Number State | CA
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