Provider Demographics
NPI:1427391200
Name:BLOOMSTEIN, NANCY NEWMAN (LICSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:NEWMAN
Last Name:BLOOMSTEIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 WALNUT ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1948
Mailing Address - Country:US
Mailing Address - Phone:617-552-5116
Mailing Address - Fax:617-552-5117
Practice Address - Street 1:288 WALNUT ST
Practice Address - Street 2:SUITE 220
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02460-1948
Practice Address - Country:US
Practice Address - Phone:617-552-5116
Practice Address - Fax:617-552-5117
Is Sole Proprietor?:No
Enumeration Date:2013-03-31
Last Update Date:2013-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10312891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical