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General NPI Number Information
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NPI Number | 1992983027
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Entity Type | Organization
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Legal Business Name | BRADLEY W BLOOM LCSW LLC
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Dates
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Enumeration Date | 01/31/2008
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Last Update Date | 09/08/2009
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Provider Practice Location Address
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Address Line | 110 OLDFIELD DR
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City | FAIRFIELD
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State | CT
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Zip | 06824-6414
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Country | US
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Telephone | 203-451-1599
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Fax |
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Provider Business Mailing Address
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Address Line | 110 OLDFIELD DR
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City | FAIRFIELD
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State | CT
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Zip | 06824-6414
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Country | US
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Telephone | 203-451-1599
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MR. BRADLEY WARREN BLOOM
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Credential | LCSW
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Telephone | 203-451-1599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 034343
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 005722
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License Number State | CT
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