Provider Demographics
NPI:1023131299
Name:KAREN W. BLOOMBERG, PH.D., LTD.
Entity type:Organization
Organization Name:KAREN W. BLOOMBERG, PH.D., LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:WAISMAN
Authorized Official - Last Name:BLOOMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-565-1349
Mailing Address - Street 1:151 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 802
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7506
Mailing Address - Country:US
Mailing Address - Phone:312-565-1349
Mailing Address - Fax:
Practice Address - Street 1:151 N MICHIGAN AVE
Practice Address - Street 2:SUITE 802
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7506
Practice Address - Country:US
Practice Address - Phone:312-565-1349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty