| Gwen S. Bloom Lcsw Llc | |
|
3322 Route 22 Suite 428 Branchburg NJ 08876-3476 | |
| (732) 501-5917 | |
| Not Available |
| Full Name | Gwen S. Bloom Lcsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 3322 Route 22, Branchburg, New Jersey |
| Authorized Official Name and Position | Gwen Susan Bloom (OWNER) |
| Authorized Official Contact | 7325015917 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gwen S. Bloom Lcsw Llc 21 Kingswood Rd Branchburg NJ 08876-7428 Ph: (732) 501-5917 | Gwen S. Bloom Lcsw Llc 3322 Route 22 Suite 428 Branchburg NJ 08876-3476 Ph: (732) 501-5917 |
| NPI Number | 1558895003 |
|---|---|
| Provider Enumeration Date | 04/11/2017 |
| Last Update Date | 03/02/2018 |
| Medicare PECOS PAC ID | 1456612555 |
|---|---|
| Medicare Enrollment ID | O20180307000351 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558895003 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 44SC05137300 (New Jersey) | Primary |
| Provider Name | Gwen S Bloom |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043415599 PECOS PAC ID: 9537451232 Enrollment ID: I20160715000546 |
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