Provider Demographics
NPI:1184327017
Name:DEEP BLUE CLINICAL SERVICES, PLLC
Entity type:Organization
Organization Name:DEEP BLUE CLINICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUMENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-377-1507
Mailing Address - Street 1:211 PAULINE DR # 1087
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-4637
Mailing Address - Country:US
Mailing Address - Phone:443-377-1507
Mailing Address - Fax:
Practice Address - Street 1:30 E PADONIA RD STE 202
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2308
Practice Address - Country:US
Practice Address - Phone:443-377-1507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health