Provider Demographics
NPI:1639878218
Name:BLUMBERG, LILIANE COSSETTE (MFT TRAINEE)
Entity Type:Individual
Prefix:
First Name:LILIANE
Middle Name:COSSETTE
Last Name:BLUMBERG
Suffix:
Gender:F
Credentials:MFT TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 SOSCOL AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-1347
Mailing Address - Country:US
Mailing Address - Phone:707-255-0966
Mailing Address - Fax:
Practice Address - Street 1:1700 SOSCOL AVE STE 5
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-1347
Practice Address - Country:US
Practice Address - Phone:707-255-0966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool