Judith F. Bloom, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

ISW01344 Issued in RI

Practice address

20 Research Pkwy
Suite C
Old Saybrook, CT 06475-4214

Phone

(800) 370-3651

Fax

(860) 510-0020

NPI assigned

Dec 27, 2006

Last updated

Aug 9, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376006400000",
    "number": "1497810683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 GROTTO AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029065517",
            "telephone_number": "401-450-5916",
            "fax_number": "860-510-0020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 RESEARCH PKWY",
            "address_2": "SUITE C",
            "city": "OLD SAYBROOK",
            "state": "CT",
            "postal_code": "064754214",
            "telephone_number": "800-370-3651",
            "fax_number": "860-510-0020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "JUDITH",
        "middle_name": "F.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-27",
        "last_updated": "2013-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "ISW01344",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHIP",
            "identifier": "413409",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "JB01344",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NHP GROUP NUMBER",
            "identifier": "1021740",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "31344-7",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katherine LM Bender, APRN
• Richard P. Benoit, D.M.D.
• Paul J. Bied, D.D.S.
• Big Y Foods, Inc. (Big Y Pharmacy #58)
• Maggie Black, PSYD
• Alyssa Bogan, PHARMD
• David Bonanno, PSYD
• Catherine M Botticelli
• Douglas Mitchell Brandt, M.D.
• Jeanne Demars Breen, M.D.

• Clinical Social Worker in Old Saybrook, CT
• Providers in Old Saybrook, 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 Aug 9, 2013; 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.