Provider Demographics
NPI:1780825661
Name:THE COMMUNITY, LLC
Entity Type:Organization
Organization Name:THE COMMUNITY, LLC
Other - Org Name:THE COMMUNITY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, MSW
Authorized Official - Phone:954-533-9818
Mailing Address - Street 1:16 NE 4TH ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-3262
Mailing Address - Country:US
Mailing Address - Phone:954-533-9818
Mailing Address - Fax:954-533-9819
Practice Address - Street 1:16 NE 4TH ST
Practice Address - Street 2:SUITE 130
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-3262
Practice Address - Country:US
Practice Address - Phone:954-533-9818
Practice Address - Fax:954-533-9819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2236106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty