Provider Demographics
NPI:1609491323
Name:BLUMENTHAL, KAYLEE (MSW)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:BLUMENTHAL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 AUTUMN RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-8008
Mailing Address - Country:US
Mailing Address - Phone:845-728-1123
Mailing Address - Fax:
Practice Address - Street 1:4 AUTUMN RIDGE WAY
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-8008
Practice Address - Country:US
Practice Address - Phone:845-728-1123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2021-01-18
Deactivation Date:2020-08-04
Deactivation Code:
Reactivation Date:2021-01-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker