Individual
DR. ANDREA L BLOOMGARDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH D
Contact information
Practice address
230 S BROAD ST STE 1305, PHILADELPHIA, PA 19102-4104
(215) 545-1175
(215) 592-4190
Mailing address
709 S MILDRED ST, PHILADELPHIA, PA 19147-2041
(215) 545-1175
(215) 592-4190
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
012038 1
NY
103TC0700X
Clinical Psychologist
B10000498
DE
103TC0700X
Clinical Psychologist
Primary
PS 006943 L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007732066
AETNA
—
01
—
1471004
HIGHMARK BLUE CROSS PPO
—
01
—
156288000
MAGELLAN
—
01
—
2128973000
KEYSTONE
—
Enumeration date
06/20/2006
Last updated
12/06/2023
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