Provider Information for 1265864425
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PHILIP BLOOMER LCSW
Sex: Male
NPI: 1265864425
Last Updated: 2018-09-11
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1265864425 | ||||||||||||
| Enumeration Date | 2013-07-30 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 800 20TH ST HUNTINGTON, WV 25703-1850 United States Phone: 304-696-8700 | Fax:304-636-8701 | ||||||||||||
| Primary Practice Address | 800 20TH ST HUNTINGTON, WV 25703-1850 United States Phone: 304-696-8700 | Fax:304-636-8701 | ||||||||||||
| Secondary Practice Address(es) | 104 S FRONT AVE | ||||||||||||
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