Provider Demographics
NPI:1083785265
Name:BLOOMBERG, JOAN G (LCSW)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:G
Last Name:BLOOMBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:979 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:OLD CHATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12136-3407
Mailing Address - Country:US
Mailing Address - Phone:518-794-8117
Mailing Address - Fax:518-794-8107
Practice Address - Street 1:979 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:OLD CHATHAM
Practice Address - State:NY
Practice Address - Zip Code:12136-3407
Practice Address - Country:US
Practice Address - Phone:518-794-8117
Practice Address - Fax:518-794-8107
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO27641-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical