Individual
GWEN BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3322 RTE 22 STE 428, BRANCHBURG, NJ 08876-3395
(732) 501-5917
Mailing address
655 E JERSEY ST, DEPT. BEHAVIORAL HEALTH & PSYCHIATRY, ELIZABETH, NJ 07206-1259
(908) 994-5000
(908) 994-5000
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
44SC05137300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44SC05137300
STATE LICENSE
NJ
Enumeration date
06/15/2007
Last updated
07/21/2022
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