Provider Demographics
NPI:1356984645
Name:RUSSELL-BLOOM, CLAIRE T (MSW,LICSW)
Entity type:Individual
Prefix:MS
First Name:CLAIRE
Middle Name:T
Last Name:RUSSELL-BLOOM
Suffix:
Gender:F
Credentials:MSW,LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 FAIR ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-2847
Mailing Address - Country:US
Mailing Address - Phone:978-270-1183
Mailing Address - Fax:
Practice Address - Street 1:20 FAIR ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2847
Practice Address - Country:US
Practice Address - Phone:978-270-1183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-20
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA1225271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health