Individual
JUDITH F. BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
20 RESEARCH PKWY, SUITE C, OLD SAYBROOK, CT 06475-4214
(800) 370-3651
(860) 510-0020
Mailing address
10 GROTTO AVE, PROVIDENCE, RI 02906-5517
(401) 450-5916
(860) 510-0020
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
ISW01344
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1021740
NHP GROUP NUMBER
—
01
—
31344-7
BLUE CROSS BLUE SHIELD
—
01
—
413409
BLUE CHIP
—
05
—
JB01344
—
RI
Enumeration date
12/27/2006
Last updated
08/09/2013
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