Provider Demographics
NPI:1790848034
Name:BLUME, RANDY LEE (MSW)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:LEE
Last Name:BLUME
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 1:202 APPLETON ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1346
Mailing Address - Country:US
Mailing Address - Phone:617-388-8693
Mailing Address - Fax:
Practice Address - Street 1:38 CRAFTS ST
Practice Address - Street 2:SQUARE PSYCHIATRY, FIRST FLOOR
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1249
Practice Address - Country:US
Practice Address - Phone:617-916-5069
Practice Address - Fax:617-467-4073
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1134821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical