Provider Demographics
NPI:1821673112
Name:BLOOM, ELAZAR ABRAHAM (LMFT)
Entity Type:Individual
Prefix:MR
First Name:ELAZAR
Middle Name:ABRAHAM
Last Name:BLOOM
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3595 SHERIDAN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3657
Mailing Address - Country:US
Mailing Address - Phone:754-600-9040
Mailing Address - Fax:
Practice Address - Street 1:3595 SHERIDAN ST STE 202
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3657
Practice Address - Country:US
Practice Address - Phone:754-600-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3358106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist