Provider Demographics
NPI:1316178890
Name:BLOOMBAUM, ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BLOOMBAUM
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 1:20807 ROSCOE BLVD
Mailing Address - Street 2:UNIT 16
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-2064
Mailing Address - Country:US
Mailing Address - Phone:818-209-1263
Mailing Address - Fax:818-734-6322
Practice Address - Street 1:20807 ROSCOE BLVD
Practice Address - Street 2:UNIT 16
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-2064
Practice Address - Country:US
Practice Address - Phone:818-209-1263
Practice Address - Fax:818-734-6322
Is Sole Proprietor?:No
Enumeration Date:2009-08-02
Last Update Date:2009-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS216141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical