Provider Demographics
NPI:1275977431
Name:LUNDBLOM, ERIC NILS (LMSW)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:NILS
Last Name:LUNDBLOM
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5690 SHAFFER RD
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-3870
Mailing Address - Country:US
Mailing Address - Phone:814-375-6817
Mailing Address - Fax:814-375-0922
Practice Address - Street 1:5690 SHAFFER RD
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-3870
Practice Address - Country:US
Practice Address - Phone:814-375-6817
Practice Address - Fax:814-375-0922
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORM5118104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker