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General NPI Number Information
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NPI Number | 1558022467
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Entity Type | Individual
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Provider Name | SUSAN R BLUM
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Gender | Female
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Dates
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Enumeration Date | 01/03/2022
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Last Update Date | 01/22/2022
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Provider Practice Location Address
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Address Line | 1010 HADDONFIELD BERLIN RD
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City | VOORHEES
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State | NJ
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Zip | 08043-3514
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Country | US
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Telephone | 602-741-6173
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Fax |
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Provider Business Mailing Address
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Address Line | 217 HADLEIGH DR
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City | CHERRY HILL
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State | NJ
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Zip | 08003-1936
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Country | US
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Telephone | 609-605-3011
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37AC00615400
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License Number State | NJ
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