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NPI Code Detail

MEDICARE: JENNIFER ANN BLOOM LMFT

MEDICARE: JENNIFER ANN BLOOM LMFT
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
1106H00000XMarriage & Family Therapist141174CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1LMFT141174OTHERCABBS LMFT REGISTRATION

General Provider Information

NPI Number : 1942961248
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER ANN BLOOM LMFT
Provider Business Mailing Address
First Line : 1833 12TH ST APT B
Second Line :
City : SANTA MONICA
State : CA
Zip : 90404-4625
Country : US
Telephone Number : 424-275-7252
Fax Number :
Provider Business Practice Location Address
First Line : 1833 12TH ST APT B
Second Line :
City : SANTA MONICA
State : CA
Zip : 90404-4625
Country : US
Telephone Number : 424-275-7252
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2022
Last Update Date : 03/14/2024

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Directions to “ JENNIFER ANN BLOOM LMFT” Practice Location

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