Jeremy W Bloomfield, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071-006685 Issued in IL

Practice address

1609 Sherman Ave
Suite 302
Evanston, IL 60201-3753

Phone

(312) 409-5614

NPI assigned

Jul 26, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235347200000",
    "number": "1871517672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1609 SHERMAN AVE",
            "address_2": "SUITE 302",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602013753",
            "telephone_number": "312-409-5614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1609 SHERMAN AVE",
            "address_2": "SUITE 302",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602013753",
            "telephone_number": "312-409-5614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOMFIELD",
        "first_name": "JEREMY",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2009-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": "071-006685",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071-006685",
            "primary": true
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "IL",
            "license": "071-006685",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mari Bliss, M.S. CCC-SLP
• Richard Blitstein, L.AC.
• Mitchell S Blivaiss, MD
• Bloom in Grace Counseling, LLC
• William David Bloomer, M.D.
• Margaret A. Bloomquist, M.S.W., L.C.S.W
• Blount Psychology Incorporated
• Melissa Ruth Blount, PH.D.
• Blue Bolt Pediatric Care
• Blue Lotus Neuropsychology, PLLC

• Clinical Psychologist in Evanston, IL
• Providers in Evanston, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2009; 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.