Provider Demographics
NPI:1891841896
Name:BLOOMBERG, DAVID N (LCSW-R)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:N
Last Name:BLOOMBERG
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 CLAY PITTS RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-3642
Mailing Address - Country:US
Mailing Address - Phone:631-853-3129
Mailing Address - Fax:631-853-8518
Practice Address - Street 1:39 LANDING AVE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2710
Practice Address - Country:US
Practice Address - Phone:631-361-3662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013965 - R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical