Lynn Marie Bloom, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

14996 Issued in MN

Practice address

5905 Golden Valley Rd
Suite 100
Golden Valley, MN 55422-4463

Phone

(763) 225-4052

Fax

(888) 965-5130

NPI assigned

Oct 3, 2014

Sex

Female

Sole proprietor

No

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

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Volunteers of America MN/Wi

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • New Hope, MN
  • NPI 1093769572
  Medicare reassignment NPD
• Volunteers of America MN/Wi

  • Community/Behavioral Health Agency
  • New Hope, MN
  • NPI 1548436090
  NPD
• Volunteers of America of Minnesota

  • Psychologist
  • Golden Valley, MN
  • NPI 1174799621
  NPD

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

{
    "created_epoch": "1412294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412294400000",
    "number": "1255734240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5905 GOLDEN VALLEY RD",
            "address_2": "SUITE 100",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224463",
            "telephone_number": "763-225-4052",
            "fax_number": "888-965-5130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5905 GOLDEN VALLEY RD",
            "address_2": "SUITE 100",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224463",
            "telephone_number": "763-225-4052",
            "fax_number": "888-965-5130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "LYNN",
        "middle_name": "MARIE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-03",
        "last_updated": "2014-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "302028",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "14996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lynne Anne Bisagno, PT
• Assiat Bjadtoeva Boke, DC
• Beth Joyce Bjork, PT
• Molly S Blackmore, LMFT
• Amy J Blehert
• Bloomington Treatment Services, LLC
• Blu Care Services LLC
• Blue Peak Consulting, LLC
• Julie Elizabeth Bluhm, LICSW
• Julien K Boayue, RN

• Clinical Social Worker in Golden Valley, MN
• Providers in Golden Valley, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.