Provider Demographics
NPI:1629111869
Name:BLOOM, CAROLYN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
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 1:384 COURT ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-4604
Mailing Address - Country:US
Mailing Address - Phone:207-782-1051
Mailing Address - Fax:207-777-6321
Practice Address - Street 1:384 COURT ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-4604
Practice Address - Country:US
Practice Address - Phone:207-782-1051
Practice Address - Fax:207-777-6321
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC21641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical