Provider Demographics
NPI:1992146435
Name:BLOOM, AMY M (LCSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:BLOOM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6865 HUNTINGTON LN APT 207
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-3011
Mailing Address - Country:US
Mailing Address - Phone:561-445-7631
Mailing Address - Fax:
Practice Address - Street 1:5851 HOLMBERG RD
Practice Address - Street 2:3514
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-4536
Practice Address - Country:US
Practice Address - Phone:561-445-7631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 72601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical