| Doctor Name: | LARRY JAY BLOOM |
| NPI Number: | 1407878051 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | 500 |
| Business Practice Address: | Of Psychology Colorado State University Ft Collins, CO - 805230001 |
| Business Phone Number: | 9704915214 |
| Business Fax Number: | |
| Mailing Address: | 1000 Southpark Drive, LITTLETON |
| State: | CO |
| Postal Code: | 801205654 |
| Phone Number: | 3037152264 |
| Fax Number: | 3037032118 |
| NPI Enumeration Date: | 07/24/2006 |
| NPI Last Update Date: | 07/28/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TH0100X |
| License Number: | 500 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | A psychologist, certified/licensed at the independent practice level in his/her state, who is duly trained and experienced in the delivery of direct, preventative, assessment, and therapeutic intervention services to individuals whose growth, adjustment, or functioning is actually impaired or is demonstrably at high risk of impairment (1974). |