MEDICARE: MS. CARLA SADIK BLUMENTHAL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	RO21640	NY

General Provider Information

NPI Number	:	1033123187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARLA SADIK BLUMENTHAL LCSW

Provider Business Mailing Address
First Line	:	506 N MIDLAND AVE
Second Line	:
City	:	NYACK
State	:	NY
Zip	:	10960-1206
Country	:	US
Telephone Number	:	845-353-3269
Fax Number	:

Provider Business Practice Location Address
First Line	:	1051 RIVERSIDE DR
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-1007
Country	:	US
Telephone Number	:	212-543-5919
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/08/2007

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