Provider Demographics
NPI:1528641776
Name:BLOOM, HALIE ROSE (LMSW)
Entity type:Individual
Prefix:
First Name:HALIE
Middle Name:ROSE
Last Name:BLOOM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 GREENPOINT AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-1991
Mailing Address - Country:US
Mailing Address - Phone:929-263-4204
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:61 GREENPOINT AVE STE 207
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-1991
Practice Address - Country:US
Practice Address - Phone:929-263-4204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127226104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker