Provider Demographics
NPI:1750997839
Name:BLUMENKEHL, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:BLUMENKEHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26215 WOODVILLA PL
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-7261
Mailing Address - Country:US
Mailing Address - Phone:248-497-9197
Mailing Address - Fax:
Practice Address - Street 1:921 E NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1393
Practice Address - Country:US
Practice Address - Phone:718-778-0485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker