Provider Demographics
NPI:1295343143
Name:TAYLOR BLOOM, CARONNE (LPC, NCC)
Entity type:Individual
Prefix:
First Name:CARONNE
Middle Name:
Last Name:TAYLOR BLOOM
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:HELLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18055-1918
Mailing Address - Country:US
Mailing Address - Phone:484-425-6250
Mailing Address - Fax:
Practice Address - Street 1:445 MAPLE RD
Practice Address - Street 2:
Practice Address - City:HELLERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18055-1918
Practice Address - Country:US
Practice Address - Phone:484-425-6250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012538101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC012538OtherSTATE BOARD OF SOCIAL WORK, MFT, AND PROF. COUNSELING