Provider Demographics
NPI:1467474924
Name:BLOOM, STEWART RICHARD (MSW)
Entity Type:Individual
Prefix:MR
First Name:STEWART
Middle Name:RICHARD
Last Name:BLOOM
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6204 JEFJEN WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-5992
Mailing Address - Country:US
Mailing Address - Phone:916-479-5047
Mailing Address - Fax:916-973-1047
Practice Address - Street 1:3650A AUBURN BOULEVARD
Practice Address - Street 2:SUITE 200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821
Practice Address - Country:US
Practice Address - Phone:916-479-5047
Practice Address - Fax:916-973-1047
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 146451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical