Provider Demographics
NPI:1982392650
Name:BLOOM, CRISTINA B (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:B
Last Name:BLOOM
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 S ALLEN ST STE 303
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-5946
Mailing Address - Country:US
Mailing Address - Phone:917-224-2138
Mailing Address - Fax:
Practice Address - Street 1:1315 S ALLEN ST STE 303
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-5946
Practice Address - Country:US
Practice Address - Phone:814-571-3136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1359821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical