Provider Demographics
NPI:1487966743
Name:ROSENBLOOM, NANCY ELLEN (MSED)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ELLEN
Last Name:ROSENBLOOM
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8625 PINTO ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1245
Mailing Address - Country:US
Mailing Address - Phone:718-465-1660
Mailing Address - Fax:
Practice Address - Street 1:6725 188TH ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-3767
Practice Address - Country:US
Practice Address - Phone:718-454-6460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool