Provider Demographics
NPI:1982820486
Name:BLUMENTHAL, LORRAINE CHRISTIE (LCSW)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:CHRISTIE
Last Name:BLUMENTHAL
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 1:160 MCKENZIE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-3114
Mailing Address - Country:US
Mailing Address - Phone:831-227-5815
Mailing Address - Fax:
Practice Address - Street 1:399 DRAKE AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-7504
Practice Address - Country:US
Practice Address - Phone:831-421-1130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW605861041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA44AVOtherMEDI-CAL PRV NBR
CAMEDI-CAL PRV NBRMedicaid