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Individual

ELLEN BLOOM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
7 RANDALL HTS, MIDDLETOWN, NY 10940-4615
(203) 731-1127
Mailing address
7 RANDALL HTS, MIDDLETOWN, NY 10940-4615
(203) 731-1127

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Enumeration date
05/06/2014
Last updated
05/06/2014
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