Provider Demographics
NPI:1568114585
Name:BLUM, DYLANA LEIGH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DYLANA
Middle Name:LEIGH
Last Name:BLUM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 16TH ST NW STE 440
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-4820
Mailing Address - Country:US
Mailing Address - Phone:202-631-1462
Mailing Address - Fax:
Practice Address - Street 1:1112 16TH ST NW STE 440
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-4820
Practice Address - Country:US
Practice Address - Phone:202-631-1462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000569103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical