Provider Demographics
NPI:1043625544
Name:BLIUME, FAY
Entity Type:Individual
Prefix:MS
First Name:FAY
Middle Name:
Last Name:BLIUME
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:FAY
Other - Middle Name:
Other - Last Name:LEVY-SHAVRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:83-87 115 ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418
Mailing Address - Country:US
Mailing Address - Phone:718-441-0155
Mailing Address - Fax:347-571-6606
Practice Address - Street 1:8387 115TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1304
Practice Address - Country:US
Practice Address - Phone:718-441-0155
Practice Address - Fax:347-571-6606
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst