Organization
REBECCA J BLOOMGARDEN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. REBECCA J BLOOMGARDEN LCSW (PRESIDENT)
(405) 692-3015
Entity
Organization
Contact information
Practice address
10400 GREENBRIAR PL, SUITE 104, OKLAHOMA CITY, OK 73159-7637
(405) 692-3015
Mailing address
10400 GREENBRIAR PL, SUITE 104, OKLAHOMA CITY, OK 73159-7637
(405) 692-3015
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1293
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
315482873-001
BC/BS OF OKLA
OK
Enumeration date
10/06/2006
Last updated
08/22/2020
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