MEDICARE: JANE BLOOMER LCSW

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	1041C0700X	Clinical Social Worker	R013966-1	NY

General Provider Information

NPI Number	:	1821068834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE BLOOMER LCSW

Provider Business Mailing Address
First Line	:	27 SOUNDVIEW AVE
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10606-3301
Country	:	US
Telephone Number	:	914-422-0040
Fax Number	:

Provider Business Practice Location Address
First Line	:	27 SOUNDVIEW AVE
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10606-3301
Country	:	US
Telephone Number	:	914-422-0040
Fax Number	:

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	11/15/2013

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