Provider Demographics
NPI:1437228277
Name:BLUMBERG, PATRICIA ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:BLUMBERG
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 1:1 EAST WYNNEWOOD ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WYNNWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096
Mailing Address - Country:US
Mailing Address - Phone:610-642-8890
Mailing Address - Fax:610-642-8986
Practice Address - Street 1:1 EAST WYNNEWOOD ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:WYNNWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096
Practice Address - Country:US
Practice Address - Phone:610-642-8890
Practice Address - Fax:610-642-8986
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW007936L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA620807J92Medicare ID - Type Unspecified