Provider Demographics
NPI:1013146224
Name:DENIS EDUARDO BLUMBERG LCSW-R
Entity Type:Organization
Organization Name:DENIS EDUARDO BLUMBERG LCSW-R
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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:LCSW-R
Authorized Official - Phone:718-541-0884
Mailing Address - Street 1:5619 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-1958
Mailing Address - Country:US
Mailing Address - Phone:718-541-0884
Mailing Address - Fax:718-366-6253
Practice Address - Street 1:285 MERRIFIELD AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-2913
Practice Address - Country:US
Practice Address - Phone:718-541-0884
Practice Address - Fax:516-764-1097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR070766-1251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02847643Medicaid