Provider Demographics
NPI:1144218421
Name:BLUM, SYDNEY L (LCSW CASAC SAP)
Entity Type:Individual
Prefix:MS
First Name:SYDNEY
Middle Name:L
Last Name:BLUM
Suffix:
Gender:F
Credentials:LCSW CASAC SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3828
Mailing Address - Country:US
Mailing Address - Phone:845-334-9878
Mailing Address - Fax:845-334-9878
Practice Address - Street 1:44 MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3828
Practice Address - Country:US
Practice Address - Phone:845-334-9878
Practice Address - Fax:845-334-9878
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR036321-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health