| Doctor Name: | STACY BLOOM |
| NPI Number: | 1013120526 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | R LCSW |
| License Number: | R0423991 |
| Business Practice Address: | 600-11-4b Pine Hollow Road East Norwich, NY - 11732 |
| Business Phone Number: | 5169226219 |
| Business Fax Number: | |
| Mailing Address: | 600-11-4b Pine Hollow Road, EAST NORWICH |
| State: | NY |
| Postal Code: | 11732 |
| Phone Number: | 5169226219 |
| Fax Number: | |
| NPI Enumeration Date: | 05/08/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | R0423991 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |