Provider Demographics
NPI:1467966606
Name:BLOOM, JENNIFER L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:BLOOM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13009 COMMUNITY CAMPUS
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-4000
Mailing Address - Country:US
Mailing Address - Phone:813-960-1848
Mailing Address - Fax:813-265-8239
Practice Address - Street 1:13009 COMMUNITY CAMPUS
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-4000
Practice Address - Country:US
Practice Address - Phone:813-960-1848
Practice Address - Fax:813-265-8239
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILSW146301041C0700X
FLSW146301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical