Provider Demographics
NPI:1609990548
Name:BLUM, RICHARD B (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:BLUM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ARAPAHOE RD
Mailing Address - Street 2:P.O. BOX 270682
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2701
Mailing Address - Country:US
Mailing Address - Phone:860-233-1897
Mailing Address - Fax:
Practice Address - Street 1:8 ARAPAHOE RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2701
Practice Address - Country:US
Practice Address - Phone:860-233-1897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1179103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist