Provider Demographics
NPI:1407071434
Name:BLOOM, NANCY LEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:LEE
Last Name:BLOOM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 ADELPHIA RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07727-3527
Mailing Address - Country:US
Mailing Address - Phone:732-539-5586
Mailing Address - Fax:
Practice Address - Street 1:338 ADELPHIA RD
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NJ
Practice Address - Zip Code:07727-3527
Practice Address - Country:US
Practice Address - Phone:732-539-5586
Practice Address - Fax:732-938-5220
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4299103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist