Healthcare Provider Details

I. General information

NPI: 1790848034
Provider Name (Legal Business Name): RANDY LEE BLUME MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 CRAFTS ST SQUARE PSYCHIATRY, FIRST FLOOR
NEWTON MA
02458-1249
US

IV. Provider business mailing address

202 APPLETON ST
CAMBRIDGE MA
02138-1346
US

V. Phone/Fax

Practice location:
  • Phone: 617-916-5069
  • Fax: 617-467-4073
Mailing address:
  • Phone: 617-388-8693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113482
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: