Provider Demographics
NPI:1811447667
Name:DENIS E BLUMBERG LCSW-R, P.C.
Entity type:Organization
Organization Name:DENIS E BLUMBERG LCSW-R, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:BLUMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R, CASAC
Authorized Official - Phone:347-563-7959
Mailing Address - Street 1:3123 TRINITY ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-3222
Mailing Address - Country:US
Mailing Address - Phone:516-445-4386
Mailing Address - Fax:718-366-3355
Practice Address - Street 1:5619 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-1958
Practice Address - Country:US
Practice Address - Phone:718-541-0884
Practice Address - Fax:718-366-3355
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENIS E BLUMBERG LCSW-R, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006452-1251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health