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Individual
MS. MICHELLE JORDANA BLOOM
Active
Individual
MS. MICHELLE JORDANA BLOOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.C.S.W.
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
72 082712
NY
1041C0700X
Clinical Social Worker
Primary
73081585
NY
Other
Enumeration date
12/14/2010
Last updated
05/13/2015
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