Provider Demographics
NPI:1437285871
Name:BLOOME, DEBORAH RENEE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:RENEE
Last Name:BLOOME
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14521 WALSINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-3342
Mailing Address - Country:US
Mailing Address - Phone:727-517-1938
Mailing Address - Fax:727-517-1937
Practice Address - Street 1:14521 WALSINGHAM RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-3342
Practice Address - Country:US
Practice Address - Phone:727-517-1938
Practice Address - Fax:727-517-1937
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5484103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54143AMedicare ID - Type Unspecified