Provider Demographics
NPI:1932267788
Name:BLOOM, DANIEL J (JD, LCSW)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:BLOOM
Suffix:
Gender:M
Credentials:JD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 W 9TH ST
Mailing Address - Street 2:6A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8945
Mailing Address - Country:US
Mailing Address - Phone:212-674-0404
Mailing Address - Fax:952-674-0400
Practice Address - Street 1:220 W 15TH ST
Practice Address - Street 2:1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6534
Practice Address - Country:US
Practice Address - Phone:212-674-0404
Practice Address - Fax:952-674-0400
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-025871-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR-0258871-1OtherLCSW LICENSE NUMBER