Provider Demographics
NPI:1295941904
Name:BLOOM, REBECCA ISADORA (LMHC)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ISADORA
Last Name:BLOOM
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:ISADORA
Other - Last Name:FELSENFELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5425 RAINIER AVE S STE A
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-2455
Mailing Address - Country:US
Mailing Address - Phone:206-380-6297
Mailing Address - Fax:
Practice Address - Street 1:5425 RAINIER AVE S STE A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-2455
Practice Address - Country:US
Practice Address - Phone:206-380-6297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00008134101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health