Provider Demographics
NPI:1831113281
Name:BLUM, VICKY SAM (LCSW)
Entity Type:Individual
Prefix:MS
First Name:VICKY
Middle Name:SAM
Last Name:BLUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 CHAPALA ST
Mailing Address - Street 2:STE C
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-7010
Mailing Address - Country:US
Mailing Address - Phone:805-965-1995
Mailing Address - Fax:805-569-1105
Practice Address - Street 1:621 CHAPALA ST
Practice Address - Street 2:STE C
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-7010
Practice Address - Country:US
Practice Address - Phone:805-965-1995
Practice Address - Fax:805-568-1105
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS171521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS29395Medicare UPIN
CASW17152Medicare ID - Type UnspecifiedLCSW