Provider Demographics
NPI:1083821946
Name:BLUMBERG, ERIC S (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:S
Last Name:BLUMBERG
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 LEROY ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-3114
Mailing Address - Country:US
Mailing Address - Phone:313-867-1090
Mailing Address - Fax:313-867-0706
Practice Address - Street 1:12010 LINWOOD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-1108
Practice Address - Country:US
Practice Address - Phone:313-867-1090
Practice Address - Fax:313-867-0706
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006393101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional