Provider Demographics
NPI:1437367356
Name:BLUM, MARTINE RUTH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARTINE
Middle Name:RUTH
Last Name:BLUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARTINE
Other - Middle Name:RUTH
Other - Last Name:BLUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:6375 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1139
Mailing Address - Country:US
Mailing Address - Phone:702-253-0818
Mailing Address - Fax:
Practice Address - Street 1:6375 W CHARLESTON BLVD STE A100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1139
Practice Address - Country:US
Practice Address - Phone:702-253-0818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5606-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical