Provider Demographics
NPI:1861153629
Name:BLOOMGARDEN, JANE W (PHD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:W
Last Name:BLOOMGARDEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 BROOKBY RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-4543
Mailing Address - Country:US
Mailing Address - Phone:914-393-7029
Mailing Address - Fax:
Practice Address - Street 1:68 BROOKBY RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-4543
Practice Address - Country:US
Practice Address - Phone:914-393-7029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYS006556-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical