Provider Demographics
NPI:1659842151
Name:BLUM, PERI MICHELLE (PSYD)
Entity type:Individual
Prefix:
First Name:PERI
Middle Name:MICHELLE
Last Name:BLUM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10440 CYPRESS LAKES PRESERVE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33449-4610
Mailing Address - Country:US
Mailing Address - Phone:561-715-1162
Mailing Address - Fax:
Practice Address - Street 1:10440 CYPRESS LAKES PRESERVE DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33449-4610
Practice Address - Country:US
Practice Address - Phone:561-715-1162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-09
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5589103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist