Provider Demographics
NPI:1730309774
Name:BLOOM, HEIKE (MA, LP)
Entity Type:Individual
Prefix:MRS
First Name:HEIKE
Middle Name:
Last Name:BLOOM
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 DORSEA RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2213
Mailing Address - Country:US
Mailing Address - Phone:717-898-8795
Mailing Address - Fax:
Practice Address - Street 1:405 W 23RD ST
Practice Address - Street 2:14 E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-1404
Practice Address - Country:US
Practice Address - Phone:212-627-7244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000227102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst