Provider Demographics
NPI:1033329891
Name:BLOOMFIELD, STEPHEN IRWIN (EDD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:IRWIN
Last Name:BLOOMFIELD
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 DUPONT STATION CT S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2518
Mailing Address - Country:US
Mailing Address - Phone:904-448-1519
Mailing Address - Fax:904-733-1340
Practice Address - Street 1:3725 DUPONT STATION CT S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2518
Practice Address - Country:US
Practice Address - Phone:904-448-1519
Practice Address - Fax:904-733-1340
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3695103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist