Provider Demographics
NPI:1073829263
Name:SWEET BLOOM, DEBORAH (MA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:SWEET BLOOM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:SWEET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:402 S 333RD ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6309
Mailing Address - Country:US
Mailing Address - Phone:206-547-9854
Mailing Address - Fax:855-816-7764
Practice Address - Street 1:402 S 333RD ST
Practice Address - Street 2:SUITE 108
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6309
Practice Address - Country:US
Practice Address - Phone:206-547-9854
Practice Address - Fax:855-816-7764
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60166936101YM0800X
WALF60233340106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health