Provider Demographics
NPI:1447031018
Name:BLOOMFIELD, CAROLYN FAYE (CPRS, CDCA)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:FAYE
Last Name:BLOOMFIELD
Suffix:
Gender:F
Credentials:CPRS, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7911 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-2815
Mailing Address - Country:US
Mailing Address - Phone:216-334-2876
Mailing Address - Fax:
Practice Address - Street 1:7911 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-2815
Practice Address - Country:US
Practice Address - Phone:216-334-2876
Practice Address - Fax:216-334-2882
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.185623101YA0400X
OHAPS.003271175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty