1740523240 NPI number — HILDA HANNAH BLOOMBERG,LICSW,INC.

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 1740523240 NPI number — HILDA HANNAH BLOOMBERG,LICSW,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HILDA HANNAH BLOOMBERG,LICSW,INC.
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:
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:
1740523240
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 GLEANER CHAPEL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
N SCITUATE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02857-1204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-369-1916
Provider Business Mailing Address Fax Number:
401-647-7719

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 GLEANER CHAPEL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
N SCITUATE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02857-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-369-1916
Provider Business Practice Location Address Fax Number:
401-647-7719
Provider Enumeration Date:
04/03/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BLOOMBERG
Authorized Official First Name:
HILDA
Authorized Official Middle Name:
HANNAH
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
401-369-1916

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  ISW01403 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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