MEDICARE: DR. JOY HOLMES BLOOM PHD

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	103TC0700X	Clinical Psychologist	0810002567	VA

General Provider Information

NPI Number	:	1689610222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOY HOLMES BLOOM PHD

Provider Business Mailing Address
First Line	:	302 GALLEON DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-2030
Country	:	US
Telephone Number	:	757-422-9343
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 N LYNNHAVEN RD
Second Line	:	SUITE 202
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-7523
Country	:	US
Telephone Number	:	757-486-6955
Fax Number	:

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

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	07/08/2007

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