Healthcare Provider Details

I. General information

NPI: 1831246909
Provider Name (Legal Business Name): CHARLOTTE BLUMENTHAL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 MONTEREY AVE
PELHAM NY
10803-2512
US

IV. Provider business mailing address

524 MONTEREY AVE
PELHAM NY
10803-2512
US

V. Phone/Fax

Practice location:
  • Phone: 914-949-7699
  • Fax: 914-949-3224
Mailing address:
  • Phone: 914-949-7699
  • Fax: 914-949-3224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number036061
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: