Alexander Geoffrey Bloom, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW76478 Issued in CA

Practice address

1030 Sir Francis Drake Blvd
Kentfield, CA 94904-1411

Phone

(152) 467-5224

NPI assigned

Sep 20, 2011

Last updated

Feb 5, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Dec 14, 2023 through Dec 14, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1316476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675555200000",
    "number": "1144503772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 LA PLACITA CT",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949451244",
            "telephone_number": "510-331-5744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 SIR FRANCIS DRAKE BLVD",
            "city": "KENTFIELD",
            "state": "CA",
            "postal_code": "949041411",
            "telephone_number": "152-467-5224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "ALEXANDER",
        "middle_name": "GEOFFREY",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-09-20",
        "last_updated": "2023-02-05",
        "certification_date": "2023-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW76478",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Philip Beitel, M.A., M.S., MFT
• Debra Michelle Bellings-Kee, MFT
• Justine Meunier Fiebelkorn Benavente, OTR/L
• Jenny Benoit
• Myra Gueco Bernecker, PH.D.
• Jillian A Boeri, LMFT
• Linda Boghrati, MFT
• David John Borgeson, MPT, MS
• Linda Christine Boyd-Cornell, L.M.F.T.
• Cynthia Bradley, DOULA

• Clinical Social Worker in Kentfield, CA
• Providers in Kentfield, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.