Provider Demographics
NPI:1144288622
Name:BLUM, LINDA FRANCES (PSYD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:FRANCES
Last Name:BLUM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 GORDONHURST AVE.
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-5000
Mailing Address - Country:US
Mailing Address - Phone:516-458-2921
Mailing Address - Fax:
Practice Address - Street 1:101 GORDONHURST AVE.
Practice Address - Street 2:
Practice Address - City:MONTLCAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043
Practice Address - Country:US
Practice Address - Phone:516-458-2921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68:016344103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical