Provider Demographics
NPI:1497298038
Name:BLUMENTHAL, CHERILYNN (BCBA)
Entity Type:Individual
Prefix:
First Name:CHERILYNN
Middle Name:
Last Name:BLUMENTHAL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 TOOMEY RD
Mailing Address - Street 2:APT 412
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-1086
Mailing Address - Country:US
Mailing Address - Phone:774-239-8763
Mailing Address - Fax:
Practice Address - Street 1:1717 TOOMEY RD
Practice Address - Street 2:APT 412
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-1086
Practice Address - Country:US
Practice Address - Phone:774-239-8763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst