Provider Demographics
NPI:1245451798
Name:BLUM, BARBARA LOUISE (PHD)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:LOUISE
Last Name:BLUM
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 1:440 W END AVE
Mailing Address - Street 2:7C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5358
Mailing Address - Country:US
Mailing Address - Phone:212-799-4607
Mailing Address - Fax:212-799-4609
Practice Address - Street 1:441 W END AVE
Practice Address - Street 2:2C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5326
Practice Address - Country:US
Practice Address - Phone:212-799-4607
Practice Address - Fax:212-799-4609
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4352103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist