Provider Demographics
NPI:1952425753
Name:BLOOM, ZACHARY (MA, RDT, LCAT)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:
Last Name:BLOOM
Suffix:
Gender:M
Credentials:MA, RDT, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370B CLAREMONT AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-1838
Mailing Address - Country:US
Mailing Address - Phone:917-687-6889
Mailing Address - Fax:
Practice Address - Street 1:370B CLAREMONT AVE APT 6
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-1838
Practice Address - Country:US
Practice Address - Phone:917-687-6889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000078221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ329OtherREGISTERED DRAMATHERAPIST
NY000078OtherCREATIVE ART THERAPIST #