Jacqueline Bloom, LCSW, PH.D.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

21324 Issued in CA

Practice address

1757 Waller St
San Francisco, CA 94117-2727

Phone

(415) 387-3684

Fax

(415) 386-0959

NPI assigned

Mar 29, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Safe & Sound

  • Marriage & Family Therapist
  • San Francisco, CA
  • NPI 1689929598
  NPD (past)

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

{
    "created_epoch": "1269820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269820800000",
    "number": "1992020374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1757 WALLER ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941172727",
            "telephone_number": "415-387-3684",
            "fax_number": "415-386-0959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1757 WALLER ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941172727",
            "telephone_number": "415-387-3684",
            "fax_number": "415-386-0959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "JACQUELINE",
        "name_prefix": "Ms.",
        "credential": "LCSW, PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-03-29",
        "last_updated": "2010-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "21324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bloom Psychotherapy PC
• Allan I. Bloom, M.D.
• Christina Bloom, RN
• Evan D Bloom, M.D.
• Howard R. Bloom, MD
• Melissa Marie Bloom, PHD
• Michael Allen Bloom II, MS
• Stephanie R. Bloom, M. D.
• Jessica Bloome, M.D.
• Bloomlife Inc

• Clinical Social Worker in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2010; 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.