Provider Demographics
NPI:1225213937
Name:BLUM, LORI PLOTKIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:PLOTKIN
Last Name:BLUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 SW 73RD ST
Mailing Address - Street 2:STE. 207
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5151
Mailing Address - Country:US
Mailing Address - Phone:305-661-6046
Mailing Address - Fax:
Practice Address - Street 1:5900 SW 73RD ST
Practice Address - Street 2:STE. 207
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5151
Practice Address - Country:US
Practice Address - Phone:305-661-6046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003719103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical