Provider Demographics
NPI:1851678932
Name:BLOOM, JODIE LAYNE (LCSW-C)
Entity Type:Individual
Prefix:MISS
First Name:JODIE
Middle Name:LAYNE
Last Name:BLOOM
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3926 FAIT AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4331
Mailing Address - Country:US
Mailing Address - Phone:410-790-1362
Mailing Address - Fax:
Practice Address - Street 1:210 E LEXINGTON ST
Practice Address - Street 2:SUITE 104
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3514
Practice Address - Country:US
Practice Address - Phone:410-878-7131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD149521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical