Provider Demographics
NPI:1114074887
Name:BLUM, JOHN JOSEPH (LPC, LCADC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JOSEPH
Last Name:BLUM
Suffix:
Gender:M
Credentials:LPC, LCADC
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 823
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-0823
Mailing Address - Country:US
Mailing Address - Phone:856-304-2469
Mailing Address - Fax:856-608-1809
Practice Address - Street 1:74 E 2ND ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3318
Practice Address - Country:US
Practice Address - Phone:856-304-2469
Practice Address - Fax:856-608-1809
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00087900101YA0400X
NJ37PC00038600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional