Provider Demographics
NPI:1689670317
Name:BLOOM, SHERRI R (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:SHERRI
Middle Name:R
Last Name:BLOOM
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 SINCLAIR LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-2029
Mailing Address - Country:US
Mailing Address - Phone:410-558-4888
Mailing Address - Fax:410-327-1694
Practice Address - Street 1:1245 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-3422
Practice Address - Country:US
Practice Address - Phone:410-558-4700
Practice Address - Fax:410-780-0364
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11537104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
S732-G054Medicare ID - Type Unspecified
P89906Medicare UPIN