Provider Demographics
NPI:1629143128
Name:BLUME, RAY A (MA)
Entity Type:Individual
Prefix:MR
First Name:RAY
Middle Name:A
Last Name:BLUME
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 LAKEVIEW DR S
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GIBBSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08026-1018
Mailing Address - Country:US
Mailing Address - Phone:856-784-5055
Mailing Address - Fax:856-784-1102
Practice Address - Street 1:146 LAKEVIEW DR S
Practice Address - Street 2:SUITE 300
Practice Address - City:GIBBSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08026-1018
Practice Address - Country:US
Practice Address - Phone:856-784-5055
Practice Address - Fax:856-784-1102
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37F100155900106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist