Provider Demographics
NPI:1255859500
Name:BLOOM, LAUREN (MA, MSSW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BLOOM
Suffix:
Gender:F
Credentials:MA, MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5830 ROSS ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1630
Mailing Address - Country:US
Mailing Address - Phone:1512-663-5772
Mailing Address - Fax:
Practice Address - Street 1:3225 LAKESHORE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2719
Practice Address - Country:US
Practice Address - Phone:510-545-6223
Practice Address - Fax:512-663-5772
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW790801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical