Gwen S. Bloom LCSW LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

44SC05137300 Issued in NJ

Legal business name

GWEN S. BLOOM LCSW LLC

Practice address

3322 Route 22
Suite 428
Branchburg, NJ 08876-3476

Phone

(732) 501-5917

NPI assigned

Apr 11, 2017

Organization subpart

No

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

Authorized official

Name

Gwen Susan Bloom, LCSWNPI 1043415599

Title

Owner

Phone

(732) 501-5917

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gwen Bloom, LCSW

  • Social Worker
  • Branchburg, NJ
  • NPI 1043415599
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1491868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519948800000",
    "number": "1558895003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 KINGSWOOD RD",
            "city": "BRANCHBURG",
            "state": "NJ",
            "postal_code": "088767428",
            "telephone_number": "732-501-5917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3322 ROUTE 22",
            "address_2": "SUITE 428",
            "city": "BRANCHBURG",
            "state": "NJ",
            "postal_code": "088763476",
            "telephone_number": "732-501-5917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GWEN S. BLOOM LCSW LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-11",
        "last_updated": "2018-03-02",
        "status": "A",
        "authorized_official_last_name": "BLOOM",
        "authorized_official_first_name": "GWEN",
        "authorized_official_middle_name": "SUSAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-501-5917",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC05137300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Branchburg, NJ
• Providers in Branchburg, NJ by specialty
• Clinical Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.