Provider Demographics
NPI:1508081191
Name:BLUM, KAREN SUSAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:SUSAN
Last Name:BLUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27 TANGLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-3407
Mailing Address - Country:US
Mailing Address - Phone:413-253-1710
Mailing Address - Fax:413-253-1718
Practice Address - Street 1:27 TANGLEWOOD RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-3407
Practice Address - Country:US
Practice Address - Phone:413-253-1710
Practice Address - Fax:413-253-1718
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA7672103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW06540OtherBLUE CROSS BLUE SHIELD