Provider Demographics
NPI:1922156454
Name:BLUMENSTOCK, LESLIE SHERRY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:SHERRY
Last Name:BLUMENSTOCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:L
Other - Middle Name:SHERRY
Other - Last Name:BLUMENSTOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2400 WELLESLEY DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-5106
Mailing Address - Country:US
Mailing Address - Phone:505-766-9361
Mailing Address - Fax:505-243-2252
Practice Address - Street 1:2400 WELLESLEY DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-5106
Practice Address - Country:US
Practice Address - Phone:505-766-9361
Practice Address - Fax:505-243-2252
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-046191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM65673727Medicaid