MEDICARE: LAUREN BLOOM LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	6801085333	MI
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1598400343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN BLOOM LMSW

Provider Business Mailing Address
First Line	:	4301 ORCHARD LAKE RD STE 180-147
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-1604
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4366 RAMSGATE LN
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-1638
Country	:	US
Telephone Number	:	517-420-0220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2022
Last Update Date	:	05/10/2022

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