Individual
DR. JEREMY W BLOOMFIELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
1609 SHERMAN AVE, SUITE 302, EVANSTON, IL 60201-3753
(312) 409-5614
Mailing address
1609 SHERMAN AVE, SUITE 302, EVANSTON, IL 60201-3753
(312) 409-5614
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
071-006685
IL
103TC0700X
Clinical Psychologist
Primary
071-006685
IL
103TP2701X
Group Psychotherapy Psychologist
071-006685
IL
Other
Enumeration date
07/26/2006
Last updated
02/23/2009
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