Provider Demographics
NPI:1124198676
Name:ROSENBLOOM, MINDY S (MD)
Entity Type:Individual
Prefix:DR
First Name:MINDY
Middle Name:S
Last Name:ROSENBLOOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 BOSWORTH ST STE 5
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-4109
Mailing Address - Country:US
Mailing Address - Phone:401-289-0250
Mailing Address - Fax:401-289-0492
Practice Address - Street 1:26 BOSWORTH ST STE 5
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-4109
Practice Address - Country:US
Practice Address - Phone:401-289-0250
Practice Address - Fax:401-289-0492
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI73162084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry