Active NPI
Rebecca Bloomgarden, LCSW
- Clinical Social Worker
- Oklahoma City, OK
National Provider Identifier
1790726172
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1293-OK LCSW
- Practice address
- 10400 Greenbriar PL
Suite 104
Oklahoma City, OK 73159-7637 - Phone
- (405) 692-3015
- NPI assigned
- Jun 9, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 1293-OK LCSW | OK | Primary |
Addresses
Primary practice location
10400 Greenbriar PL
Suite 104
Oklahoma City, OK 73159-7637
Mailing address
10400 Greenbriar PL
Suite 104
Oklahoma City, OK 73159-7637
Phone (405) 692-3015
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2023 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1293-OK LCSW | OK | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1790726172",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10400 GREENBRIAR PL",
"address_2": "SUITE 104",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731597637",
"telephone_number": "405-692-3015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10400 GREENBRIAR PL",
"address_2": "SUITE 104",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731597637",
"telephone_number": "405-692-3015"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLOOMGARDEN",
"first_name": "REBECCA",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OK",
"license": "1293-OK LCSW",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.