Provider Demographics
NPI:1407868763
Name:BLOOM-CHARETTE, LISA D (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:D
Last Name:BLOOM-CHARETTE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:D
Other - Last Name:BLOOM-CHARETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:182 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1024
Mailing Address - Country:US
Mailing Address - Phone:781-275-8530
Mailing Address - Fax:
Practice Address - Street 1:200 SPRINGS RD
Practice Address - Street 2:116B
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1114
Practice Address - Country:US
Practice Address - Phone:781-687-2669
Practice Address - Fax:781-687-3025
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5095103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist