MEDICARE: ALICIA BLOOMER

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	087913	NY

General Provider Information

NPI Number	:	1881115293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA BLOOMER

Provider Business Mailing Address
First Line	:	1807 AVENUE P
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1337
Country	:	US
Telephone Number	:	347-708-0777
Fax Number	:

Provider Business Practice Location Address
First Line	:	1807 AVENUE P
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1337
Country	:	US
Telephone Number	:	347-708-0777
Fax Number	:	347-708-0777

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

Provider Enumeration Date	:	07/06/2017
Last Update Date	:	07/06/2017

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Directions to “ ALICIA BLOOMER ” Practice Location

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