Active NPI
Jan Hettie Bloom, PHD.
- Psychologist
- Newton Highlands, MA
National Provider Identifier
1184724783
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 3381
- Practice address
- 4 - 8 Hartford Street
Newton Highlands, MA 02461-1913 - Phone
- (617) 243-6327
- Fax
- (617) 244-4558
- NPI assigned
- Sep 23, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 3381 | MA | Primary |
Addresses
Primary practice location
4 - 8 Hartford Street
Newton Highlands, MA 02461-1913
Mailing address
23 Moffat Rd
Waban, MA 02468-1112
Phone (617) 243-6327
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3381 | MA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158969600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1184724783",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23 MOFFAT RD",
"city": "WABAN",
"state": "MA",
"postal_code": "024681112",
"telephone_number": "617-243-6327",
"fax_number": "617-244-4558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4 - 8 HARTFORD STREET",
"city": "NEWTON HIGHLANDS",
"state": "MA",
"postal_code": "024611913",
"telephone_number": "617-243-6327",
"fax_number": "617-244-4558"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLOOM",
"first_name": "JAN",
"middle_name": "HETTIE",
"name_prefix": "Dr.",
"credential": "PHD.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "3381",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newton Highlands, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.