| Victoria Blom Lcsw Llc | |
|
318 Main St Ste 205 Millburn NJ 07041-1181 | |
| (413) 885-5763 | |
| Not Available |
| Full Name | Victoria Blom Lcsw Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 318 Main St Ste 205, Millburn, New Jersey |
| Authorized Official Name and Position | Victoria V Blom (SOLE MEMBER) |
| Authorized Official Contact | 4138855763 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Victoria Blom Lcsw Llc 318 Main St Ste 205 Millburn NJ 07041-1181 Ph: (413) 885-5763 | Victoria Blom Lcsw Llc 318 Main St Ste 205 Millburn NJ 07041-1181 Ph: (413) 885-5763 |
| NPI Number | 1861967713 |
|---|---|
| Provider Enumeration Date | 10/08/2018 |
| Last Update Date | 10/08/2018 |
| Medicare PECOS PAC ID | 6507110731 |
|---|---|
| Medicare Enrollment ID | O20181107000420 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861967713 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Victoria V Blom |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396272142 PECOS PAC ID: 9638425218 Enrollment ID: I20180712001027 |
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