Bradley Warren Bloom

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

005722 Issued in CT

Practice address

1101 Mill Hill Rd
Southport, CT 06890-3020

Phone

(203) 451-1599

Fax

(203) 451-1599

NPI assigned

May 7, 2025

Last updated

May 7, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 16, 2025 through Apr 16, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

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

• Bradley W Bloom LCSW LLC

  • Social Worker
  • Fairfield, CT
  • NPI 1992983027
  Authorized official Same address or phone

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

{
    "created_epoch": "1746576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746576000000",
    "number": "1285424804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 MILL HILL RD",
            "city": "SOUTHPORT",
            "state": "CT",
            "postal_code": "068903020",
            "telephone_number": "203-451-1599",
            "fax_number": "203-451-1599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 MILL HILL RD",
            "city": "SOUTHPORT",
            "state": "CT",
            "postal_code": "068903020",
            "telephone_number": "203-451-1599",
            "fax_number": "203-451-1599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "BRADLEY",
        "middle_name": "WARREN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-05-07",
        "last_updated": "2025-05-07",
        "certification_date": "2025-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "005722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Krupa Baxi, OD
• Debra Ann Belanger, MA, LMFT
• Donald C Bell, MD
• Angelina M Bello, LCSW
• Anne-Line Blanco
• Judy L Boslow, M.D.
• Gretchen H Brandt, L.M.F.T.
• Janet Brown Mendell, MA, LMFT
• Stephanie Rose Buturla, LPC
• Maria Vittoria Carnevale, ANP

• Clinical Social Worker in Southport, CT
• Providers in Southport, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2025; 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.