Provider Demographics
NPI:1548270994
Name:BLOOMFIELD, SERENA LURIE (EDD)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:LURIE
Last Name:BLOOMFIELD
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 DUPONT STATION CT S
Mailing Address - Street 2:SUITE 3
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2518
Mailing Address - Country:US
Mailing Address - Phone:904-448-1519
Mailing Address - Fax:904-733-1340
Practice Address - Street 1:3725 DUPONT STATION CT S
Practice Address - Street 2:SUITE 3
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2518
Practice Address - Country:US
Practice Address - Phone:904-448-1519
Practice Address - Fax:904-733-1340
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004692103TC0700X, 103TC2200X, 103TF0200X
MA3957103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic