Provider Demographics
NPI:1245982206
Name:BLUMENTHAL, LIESL (CAC-AD, LMSW)
Entity type:Individual
Prefix:
First Name:LIESL
Middle Name:
Last Name:BLUMENTHAL
Suffix:
Gender:F
Credentials:CAC-AD, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4C NORTH AVE STE 432
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2330
Mailing Address - Country:US
Mailing Address - Phone:410-979-8484
Mailing Address - Fax:
Practice Address - Street 1:1220 E JOPPA RD BLDG B
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5811
Practice Address - Country:US
Practice Address - Phone:410-449-4955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC3038101YA0400X
MD299531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)