Ada M Bloom, LISW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I9849 Issued in OH

Practice address

1925 Hayes Ave
Sandusky, OH 44870-4737

Phone

(419) 557-5177

Fax

(419) 557-5179

NPI assigned

Dec 29, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Mickie Bloom Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Firelands Regional Medical Center

  • General Acute Care Hospital
  • Sandusky, OH
  • NPI 1285392936
  NPD (past)
• Wellness Counseling Solutions, LLC

  • Mental Health Counselor
  • Upper Sandusky, OH
  • NPI 1871249508

  Clinical

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1262044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1262044800000",
    "number": "1003146853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 HAYES AVE",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448704737",
            "telephone_number": "419-557-5177",
            "fax_number": "419-557-5179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 HAYES AVE",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448704737",
            "telephone_number": "419-557-5177",
            "fax_number": "419-557-5179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "ADA",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-12-29",
        "last_updated": "2009-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I9849",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICKIE",
            "last_name": "BLOOM",
            "prefix": "MS.",
            "credential": "LISW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jeremy Thomas Blackston, DPT
• Sarah Blake
• Michael S Blank, MD
• Thomas Blanton, PT
• Bloom and Grow Psychological Services LLC
• Robert Blue, PT
• Marlene P Boas, PH.D., LPCC
• David A. Bodi, D.C.
• Joseph Edward Bodi, CDCA
• Michelle E Bodie, PAC

• Clinical Social Worker in Sandusky, OH
• Providers in Sandusky, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.