| Bradley W Bloom Lcsw Llc | |
|
110 Oldfield Dr Fairfield CT 06824-6414 | |
| (203) 451-1599 | |
| Not Available |
| Full Name | Bradley W Bloom Lcsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 110 Oldfield Dr, Fairfield, Connecticut |
| Authorized Official Name and Position | Bradley Warren Bloom (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 2034511599 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bradley W Bloom Lcsw Llc 110 Oldfield Dr Fairfield CT 06824-6414 Ph: (203) 451-1599 | Bradley W Bloom Lcsw Llc 110 Oldfield Dr Fairfield CT 06824-6414 Ph: (203) 451-1599 |
| NPI Number | 1992983027 |
|---|---|
| Provider Enumeration Date | 01/31/2008 |
| Last Update Date | 09/08/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992983027 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | 005722 (Connecticut) | Primary |
| 104100000X | Social Worker | 034343 (New York) | Secondary |
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