Provider Demographics
NPI:1285699884
Name:BLOOM, BARBARA LIEBERMAN (PHD)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:LIEBERMAN
Last Name:BLOOM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9485 SUNSET DR
Mailing Address - Street 2:SUITE A202
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3242
Mailing Address - Country:US
Mailing Address - Phone:305-595-1909
Mailing Address - Fax:305-271-2088
Practice Address - Street 1:9485 SUNSET DR
Practice Address - Street 2:SUITE A202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3242
Practice Address - Country:US
Practice Address - Phone:305-595-1909
Practice Address - Fax:305-271-2088
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL73446174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73446Medicare ID - Type Unspecified