Provider Demographics
NPI:1629566104
Name:BLOOM, MARJORIE ENID (MSW, MPH, LICSW)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ENID
Last Name:BLOOM
Suffix:
Gender:F
Credentials:MSW, MPH, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 BEEKMAN DR
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-2605
Mailing Address - Country:US
Mailing Address - Phone:413-433-1590
Mailing Address - Fax:413-794-5100
Practice Address - Street 1:759 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01199-1001
Practice Address - Country:US
Practice Address - Phone:413-794-5559
Practice Address - Fax:413-794-5100
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1059841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical