Provider Demographics
NPI:1902974462
Name:BLOOM, CASSIA LEA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CASSIA
Middle Name:LEA
Last Name:BLOOM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 BETHANY DR
Mailing Address - Street 2:STE E
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-2861
Mailing Address - Country:US
Mailing Address - Phone:831-588-8032
Mailing Address - Fax:
Practice Address - Street 1:125 BETHANY DR
Practice Address - Street 2:STE E
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-2861
Practice Address - Country:US
Practice Address - Phone:831-588-8032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45342106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist