Provider Demographics
NPI:1770882607
Name:BLOOM, RACHEL LAUREN (LMSW)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LAUREN
Last Name:BLOOM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:LAUREN
Other - Last Name:GERSHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:12 FRANKLIN PL
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1294
Mailing Address - Country:US
Mailing Address - Phone:516-374-3671
Mailing Address - Fax:516-374-7864
Practice Address - Street 1:112 FRANKLIN PLACE
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598
Practice Address - Country:US
Practice Address - Phone:516-374-3671
Practice Address - Fax:516-374-7864
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-17
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0780351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical