Provider Demographics
NPI:1114998481
Name:BLOOM, HAROLD (LCSW)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:BLOOM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 MERIWEATHER DR
Mailing Address - Street 2:STE 102
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-3046
Mailing Address - Country:US
Mailing Address - Phone:706-227-7204
Mailing Address - Fax:706-227-7225
Practice Address - Street 1:250 NORTH AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-2244
Practice Address - Country:US
Practice Address - Phone:706-542-9739
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0002721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical