Provider Demographics
NPI:1144040098
Name:BLOOM, SCOTT HARRIS (LCSW)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:HARRIS
Last Name:BLOOM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 DRAPER LN APT 2BN
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-1014
Mailing Address - Country:US
Mailing Address - Phone:845-801-7560
Mailing Address - Fax:
Practice Address - Street 1:17620 148TH AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-5518
Practice Address - Country:US
Practice Address - Phone:347-352-1518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR041634-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical