1396272993 NPI number — BLOOM PSYCHOTHERAPY NYC LCSW PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396272993 NPI number — BLOOM PSYCHOTHERAPY NYC LCSW PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLOOM PSYCHOTHERAPY NYC LCSW PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396272993
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 OCEAN AVE APT 5H
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11225-4724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-626-3847
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 W 34TH ST PH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10001-3006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-830-6035
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2017

Additional Information

Authorized Official

Authorized Official Last Name:
KALYANAM
Authorized Official First Name:
ANUPAMA
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE OWNER/ PRESIDENT
Authorized Official Telephone Number:
917-830-6035

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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