Provider Demographics
NPI:1811259500
Name:BLUM, CAROL ROSS (MA SPED)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ROSS
Last Name:BLUM
Suffix:
Gender:F
Credentials:MA SPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2985 CHERYL RD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-5402
Mailing Address - Country:US
Mailing Address - Phone:516-659-2655
Mailing Address - Fax:516-378-6744
Practice Address - Street 1:2985 CHERYL RD
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-5402
Practice Address - Country:US
Practice Address - Phone:516-659-2655
Practice Address - Fax:516-378-6744
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist