Provider Demographics
NPI:1467526640
Name:BLUMBERG, DENIS EDUARDO (LCSW, CASAC)
Entity Type:Individual
Prefix:MR
First Name:DENIS
Middle Name:EDUARDO
Last Name:BLUMBERG
Suffix:
Gender:M
Credentials:LCSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 MERRIFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-2913
Mailing Address - Country:US
Mailing Address - Phone:718-541-0884
Mailing Address - Fax:
Practice Address - Street 1:5619 METROPOLITAN AVE FL 1
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-1958
Practice Address - Country:US
Practice Address - Phone:718-366-6252
Practice Address - Fax:718-366-6253
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070766-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health