Provider Demographics
NPI:1578646295
Name:BLOOM, BARBARA LYNN (LCSW)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:LYNN
Last Name:BLOOM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:LYNN
Other - Last Name:BLOOM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:55 EAST END AVENUE
Mailing Address - Street 2:14M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-8062
Mailing Address - Country:US
Mailing Address - Phone:917-319-0524
Mailing Address - Fax:212-262-3181
Practice Address - Street 1:55 EAST END AVENUE
Practice Address - Street 2:14M
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-8062
Practice Address - Country:US
Practice Address - Phone:212-262-8179
Practice Address - Fax:212-262-3181
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03434011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical