Provider Demographics
NPI:1588650691
Name:BLUME, ELLEN SUE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:SUE
Last Name:BLUME
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 ELM PL
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-4246
Mailing Address - Country:US
Mailing Address - Phone:516-379-4731
Mailing Address - Fax:
Practice Address - Street 1:28 ELM PL
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-4246
Practice Address - Country:US
Practice Address - Phone:516-379-4731
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0190031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical