Provider Demographics
NPI:1760560239
Name:BLOOM, CAROLINE CURTIS (MSSW)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:CURTIS
Last Name:BLOOM
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CONCORD LN
Mailing Address - Street 2:
Mailing Address - City:OSTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02655-1258
Mailing Address - Country:US
Mailing Address - Phone:508-420-0583
Mailing Address - Fax:
Practice Address - Street 1:101 CONCORD LN
Practice Address - Street 2:
Practice Address - City:OSTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02655-1258
Practice Address - Country:US
Practice Address - Phone:508-420-0583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA102434104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
059627OtherVALUE OPTIONS
R41196OtherTRI CARE
059627OtherVALUE OPTIONS
P01165Medicare ID - Type Unspecified