Provider Demographics
NPI:1811231186
Name:BLUM, CAROL ANN (MED, CAC, LPC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:BLUM
Suffix:
Gender:F
Credentials:MED, CAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2446 ASPEN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2504
Mailing Address - Country:US
Mailing Address - Phone:267-978-8089
Mailing Address - Fax:
Practice Address - Street 1:2446 ASPEN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-2504
Practice Address - Country:US
Practice Address - Phone:267-978-8089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003059101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional