Provider Demographics
NPI:1932826997
Name:BLOMBERG, BILLY EUGENE (BCPC)
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:EUGENE
Last Name:BLOMBERG
Suffix:
Gender:M
Credentials:BCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4826 BAYMEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4706
Mailing Address - Country:US
Mailing Address - Phone:904-580-5755
Mailing Address - Fax:
Practice Address - Street 1:4826 BAYMEADOWS RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4706
Practice Address - Country:US
Practice Address - Phone:904-580-5755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral