Provider Demographics
NPI:1942225008
Name:GOLDBLUM, NAOMI SARA (PHD)
Entity Type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:SARA
Last Name:GOLDBLUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12695 MCMANUS BLVD BLDG 8
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-4442
Mailing Address - Country:US
Mailing Address - Phone:757-877-7700
Mailing Address - Fax:757-872-7211
Practice Address - Street 1:12695 MCMANUS BLVD BLDG 8
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4442
Practice Address - Country:US
Practice Address - Phone:757-877-7700
Practice Address - Fax:757-872-7211
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001327103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7793146Medicaid