Provider Demographics
NPI:1255576153
Name:BLUMKIN, ZACHARY KALMAN (PSYD)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:KALMAN
Last Name:BLUMKIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 UNION ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1314
Mailing Address - Country:US
Mailing Address - Phone:781-477-7222
Mailing Address - Fax:781-598-8137
Practice Address - Street 1:23 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1220
Practice Address - Country:US
Practice Address - Phone:781-477-7222
Practice Address - Fax:781-598-8137
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY019728103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program