Provider Demographics
NPI:1043887946
Name:BLUM, VALERIE ELLEN (MA, TSSLD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:ELLEN
Last Name:BLUM
Suffix:
Gender:F
Credentials:MA, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-0309
Mailing Address - Country:US
Mailing Address - Phone:516-808-3824
Mailing Address - Fax:
Practice Address - Street 1:1605 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4315
Practice Address - Country:US
Practice Address - Phone:516-808-3824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program