Provider Demographics
NPI:1851696397
Name:DENIS EDUARDO BLUMBERG, LCSW, P.C.
Entity Type:Organization
Organization Name:DENIS EDUARDO BLUMBERG, LCSW, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW-R
Authorized Official - Prefix:MR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:BLUMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-541-0884
Mailing Address - Street 1:285 MERRIFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-2913
Mailing Address - Country:US
Mailing Address - Phone:347-563-7959
Mailing Address - Fax:
Practice Address - Street 1:5619 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-1958
Practice Address - Country:US
Practice Address - Phone:718-541-0884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0707661101YA0400X, 101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02847643Medicaid