Provider Demographics
NPI:1265549315
Name:BLUME, GINGER ELAINE (PH D)
Entity type:Individual
Prefix:MRS
First Name:GINGER
Middle Name:ELAINE
Last Name:BLUME
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:100 RIVERVIEW CENTER
Mailing Address - Street 2:SUITE 314
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457
Mailing Address - Country:US
Mailing Address - Phone:860-346-6020
Mailing Address - Fax:860-346-6023
Practice Address - Street 1:100 RIVERVIEW CENTER
Practice Address - Street 2:SUITE 314
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457
Practice Address - Country:US
Practice Address - Phone:860-346-6020
Practice Address - Fax:860-346-6023
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT878103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004047916Medicaid
CT004047916Medicaid