Provider Demographics
NPI:1235893603
Name:ANNA KIRSHBLUM LLC
Entity Type:Organization
Organization Name:ANNA KIRSHBLUM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUDIM-KIRSHBLUM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:973-499-0401
Mailing Address - Street 1:71 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2930
Mailing Address - Country:US
Mailing Address - Phone:973-449-0401
Mailing Address - Fax:
Practice Address - Street 1:71 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2930
Practice Address - Country:US
Practice Address - Phone:973-449-0401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health