Provider Demographics
NPI:1538316369
Name:BLOOM, RACHAEL ELAINE (LCSW)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:ELAINE
Last Name:BLOOM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:ELAINE
Other - Last Name:ORLIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11420 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-8807
Mailing Address - Country:US
Mailing Address - Phone:310-365-8394
Mailing Address - Fax:
Practice Address - Street 1:12304 SANTA MONICA BLVD STE 215A
Practice Address - Street 2:
Practice Address - City:WEST LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2587
Practice Address - Country:US
Practice Address - Phone:310-365-8394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA617911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical