Tina Bloom, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

020552-1 Issued in NY

Practice address

3512 Quentin Rd Suite 110 Che Services
Brooklyn, NY 11234

Phone

(800) 275-3243

Fax

(855) 688-6746

NPI assigned

Oct 17, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1224201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537833600000",
    "number": "1437301710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86 AURORA AVE",
            "city": "WEST SENECA",
            "state": "NY",
            "postal_code": "142241123",
            "telephone_number": "814-227-6376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3512 QUENTIN RD SUITE 110 CHE SERVICES",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11234",
            "telephone_number": "800-275-3243",
            "fax_number": "855-688-6746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "TINA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-10-17",
        "last_updated": "2018-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "PA",
            "license": "PC - 004932",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "020552-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED PROFESSIONAL COUNSELOR",
            "identifier": "PC - 004932",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bloom Therapy Mental Health Counseling PLLC
• Akivah M Bloom, M.S. ED
• Halie Rose Bloom, LMSW
• Jessica Bloom, LCSW
• Liza Rebecca Bloom
• Bloomer Health PT, OT, SLP Services, PLLC
• Alicia Bloomer
• Aldene Roxanne Bloomfield, MD
• Alison Bloomfield, PHD, NCSP
• Kimberley Bloomfield, M.D.

• Psychologist in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2018; 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.