Provider Demographics
NPI:1265642300
Name:BLUMENFELD, NINA (LCSW)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:BLUMENFELD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 BERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-2623
Mailing Address - Country:US
Mailing Address - Phone:516-921-2442
Mailing Address - Fax:516-921-8707
Practice Address - Street 1:26 BERRY HILL RD
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-2623
Practice Address - Country:US
Practice Address - Phone:516-921-2442
Practice Address - Fax:516-921-8707
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR022558-21041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical