Provider Demographics
NPI:1932215381
Name:BLOOMFIELD, MAGGIE J (LCSWR, CASAC, SAP)
Entity Type:Individual
Prefix:MS
First Name:MAGGIE
Middle Name:J
Last Name:BLOOMFIELD
Suffix:
Gender:F
Credentials:LCSWR, CASAC, SAP
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:
Other - Last Name:GARI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:C/O INTEGRATIVE COUNSELING SERVICES
Mailing Address - Street 2:10 OAK #3
Mailing Address - City:WESTHAMPTON BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11978
Mailing Address - Country:US
Mailing Address - Phone:631-288-6399
Mailing Address - Fax:631-288-8576
Practice Address - Street 1:C/O INTEGRATIVE COUNSELING SERVICES
Practice Address - Street 2:10 OAK #3
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978
Practice Address - Country:US
Practice Address - Phone:631-288-6399
Practice Address - Fax:631-288-8576
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
5915101YA0400X
12685101YA0400X
NYPR057530103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
P1244591OtherOXFORD
MDNYOtherAA73619
NY 4361Medicare ID - Type Unspecified
P1244591OtherOXFORD