Provider Demographics
NPI:1073745410
Name:DEBORAH BLOOME, PSY.D. PA
Entity Type:Organization
Organization Name:DEBORAH BLOOME, PSY.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BLOOME
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:727-517-1938
Mailing Address - Street 1:14521 WALSINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-3342
Mailing Address - Country:US
Mailing Address - Phone:727-517-1938
Mailing Address - Fax:
Practice Address - Street 1:14521 WALSINGHAM RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-3342
Practice Address - Country:US
Practice Address - Phone:727-517-1938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-19
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54143AMedicare PIN