Provider Demographics
NPI:1134582612
Name:BLUMENFELD, DONNA (LPCC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:BLUMENFELD
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5304 CIRCITA DEL NORTE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4932
Mailing Address - Country:US
Mailing Address - Phone:602-931-1710
Mailing Address - Fax:
Practice Address - Street 1:1919 5TH ST STE O
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6012
Practice Address - Country:US
Practice Address - Phone:505-461-1219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0207031101YP2500X, 101YM0800X
NM101YM0800X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1134582612Medicaid