Provider Demographics
NPI:1700972940
Name:BLUM, LORRAINE J (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:LORRAINE
Middle Name:J
Last Name:BLUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6352 OVERLAND DR
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484
Mailing Address - Country:US
Mailing Address - Phone:954-784-2845
Mailing Address - Fax:
Practice Address - Street 1:6352 OVERLAND DR
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484
Practice Address - Country:US
Practice Address - Phone:954-784-2845
Practice Address - Fax:954-785-5808
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW11941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ1744Medicare ID - Type UnspecifiedMEDICARE NUMBER