Provider Demographics
NPI:1033279062
Name:BLUM, SUSAN LEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LEE
Last Name:BLUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 WEST END AVENUE
Mailing Address - Street 2:APARTMENT 7C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5538
Mailing Address - Country:US
Mailing Address - Phone:646-234-3027
Mailing Address - Fax:
Practice Address - Street 1:771 W END AVE APT 7C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5538
Practice Address - Country:US
Practice Address - Phone:646-234-3027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0777391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical